DME BILLING

Providing billing services for Durable Medical Equipment (DME), or Home Medical Equipment (HME) as they are sometimes called, can be a time-consuming and tedious affair. Among other things, it requires in-depth knowledge of reimbursement guidelines of Medicare, Medicaid and Commercial Plans. It also requires constant adherence to quality and staying abreast of all the changes happening in reimbursement regulations and coding & documentation requirements.

NascentPath has a highly capable team of DME billing experts who can make life easier for you from the very first day. With NascentPath by your side, you can leave all your DME billing worries to our expert care. Outsourcing your DME billing requirements to us will allow you and your staff to concentrate on marketing and growing your business, rather than managing a billing and collections department.

Our experience shows that the process for DMEPOS billing can be cumbersome due to its inherent challenges with the order getting generated from the physician’s office. This increases complications and the turn-around time as dependencies increase. DME, Prosthetics & Orthotics companies need to devote much time coordinating and communicating with the ordering physician’s office for a valid Rx, medical/therapy notes, etc. Equipment that requires prior authorization also involves innumerable follow-up calls.

This is all managed effectively by us through our methodical and streamlined process that tracks each request in detail ensuring timely follow-up. Payor guidelines are specific to diagnosis and a thorough knowledge of this will result in drastically reducing denials. Our diligent physician and payor follow-up activities also help reduce turn-around time and improve cash flow.

The process starts with entry of orders and ends when the account has a zero balance. This includes conducting eligibility checks, obtaining authorization, creating sales orders, scheduling delivery, submitting claims, managing rejections and denials, and proactively following-up on A/R.

OUR COMPLETE APPROACH TO DMEPOS BILLING

• Initial Visit Appointment Setup (done by Practice)
• Order Entry
  • ​Patient Account Creation
  • Patient’s demographic entry
  • Prescription information entry
• Order Entry
  • ​​Creation of Insurance verification form
  • Checking general eligibility and benefits information and updating in OPIE
• Initial Evaluation Appointment (done by Practitioner)
  • ​L-Codes assignment
  • Measurements (If required)
  • Creation of Evaluation form/Notes/Other Medical Records
• Detailed Eligibility Verification & Authorization Requirement Checking
  • ​Verification of eligibility with assigned codes
  • Updating detailed code specific benefit
  • Checking authorization requirements (Code Specific)
  • Creation of Service Estimates (Payer Specific and Reasonable and Customary)
  • Sending detailed written order/diabetic verification form and other paperwork to doctor’s office for signature
• Doctor’s Office Follow-up
  • Contacting doctor’s office for pending detailed written order/diabetic verification form and other paperwork
• Authorization/Pre-Determination/Referral Initiation
  • Creation of Insurance Authorization Form
  • Requesting Authorization/Pre-Determination/Referral (Via Phone/Fax/Email)
• Authorization/Pre-Determination/Referral Follow-up
  • ​Follow-up with payer on Authorization/Pre-Determination/Referral status
  • Completion of authorization form based on the outcome of the request