Durable Medical Equipment’s (DME) are therapeutic items that is prescribed by physicians to patients who suffer from a medical condition. Durable medical equipment or home medical equipment billing is complicated with already associated medical condition and need for equipment’s to maintain the health scenarios of patient.

Healthcare providers dealing with patients having preconditions that demand DME or will need DME have to mention the pre-conditions during prior-authorization to get billed. In January 2021, CMS released a DMEPOS fee schedule amount, it again released it on April 2021 with revised durable medical equipment bidding program. Legion Healthcare Solution (LHS) understands the growing concern among physicians about the bidding program resulting into revenue loss and claim denials due to use of modifiers. CMS recently was able to identify multiple calculation errors where the fee schedule amount decreased by 30 percent or increased by 57 percent.

“Modifiers use in DME billing needs to accurate and even relatable to the earlier diagnosis of the patient. Most equipment providers make an error during documentation and prior authorization leading to part payment or complete denial of the claim.”

– AR expert in DME

DME provider requires credentialing in accordance with BCBSNC medical policy before being paid for equipment’s. LHS has team credentialing experts of that works 24/7 on credentialing to remove the system glitches.

Payers require purchase or rent prescription before being eligible for coverage, with LHS team providers can build a comprehensive process for each equipment authorization. LHS has DME billing experts looking at each prescription for errors that could lead to denials.

DME documentation is imperative in case the HCPCS codes aren’t available for the items. LHS will submit a complete description of the item, factory invoice of the equipment, and a medical necessity certificate along with physician’s signature.

DME renting is one other process many providers find complicated, renting of equipment is based on patient prescribed time-frame of use and total cost. Legion Durable medical billing understand that total cost of rent cannot be greater than equipment cost. The start day of the service and last date of equipment renting along with modifier RR are some of the aspects every provider needs to consider.

Documentation support for all equipment’s from first contact to complete buying or renting cycle.

Eligibility check before beginning the DME billing cycle, gives a complete perspective about coverage and out of pocket payment.

Advanced statement analytics from physicians and patient to improve the reimbursement amount.

To ensure maximum reimbursement LHS scheduled claim follow-up for all equipment’s.

API- and RPM-driven technology approach to improve patient experience.