In the healthcare industry, billing for durable medical equipment follows special rules, coding systems and insurance policies. Moreover, DMEPOS is a general category that includes durable medical equipment. These consist of:
- Wheelchairs, walkers, and hospital beds
- Infusion pumps and glucose strips
- Prosthetics: Man-made appendages
- Orthotics: neck supports and braces
To be eligible for payment, every DMEPOS item needs to be prescribed, reusable, and used for a medical reason.
The goal of this article is to give a thorough review of DME in medical billing, including its definitions, essential elements, difficulties, and potential developments. Healthcare organizations may improve their revenue cycle management and guarantee prompt reimbursements for the vital equipment they supply to patients by learning about efficient billing procedures.
What is DME in medical billing?
Medical equipment is used for treatment or chronic care management. Medical professionals prescribe them for appropriate use at home. These include hospital beds, wheelchairs, and oxygen apparatus. Effective billing and reimbursement procedures are required for DME classification and requirements.
Medicare defines DME as equipment that satisfies the following requirements in order to be eligible for reimbursement:
- able to endure frequent use
- Fulfils a specific medical function.
- Is appropriate for domestic use.
- Is useless to someone who is not unwell or injured.
- Is recommended by a qualified healthcare provider.
According to CMS regulations, devices intended for comfort or general convenience such as massaging chairs, heating pads, or air purifiers do not count as DME.
Common types of DME include:
- Mobility aids for people with restricted mobility include wheelchairs and scooters.
E1130 is an example HCPCS code for a standard wheelchair with desk length, swing away footrests, and detachable arms.
- Oxygen Equipment: Tools for giving patients with respiratory disorders more oxygen.
E0431 is an example of a portable gaseous oxygen system HCPCS code.
- Hospital Beds: Patients recuperating at home can get comfort and support from these movable beds.
E0260 is an example HCPCS code for a hospital bed that is semi-electric.
- Walkers for patients assist in mobility. The HCPCS code used for it is E0143.
- HCPCS code used for adjustable knee orthosis is L1833. These devices are used to support body parts such as braces for the neck or artificial limbs.
- HCPCS code used for infusion pump is E0781. These instruments are used to administer drugs for either acute or chronic illnesses.
DME’s Function in Patient Care
DME’s are helpful in assisting patients while providing treatments. These equipments improve general wellbeing of patients and help them move independently.  Delay in these equipment provisions due to insurance verification, authorization, or billing mistakes may have direct impact on patient outcomes. In time billing and clean claims with complete documentation may help in quick reimbursements.
Essential Elements of DME Billing
A number of essential elements are involved in efficient DME billing, which supports both correct reimbursement and regulatory compliance.
1. Precise Records
Complete documentation with accuracy helps in successful claim submission and processing. In the DME billing procedure, patient information, equipments and treatment details need to be entered correctly for claims submissions.
A physician order certificate is required for equipment medical necessity that is essential for DME billing. Another important record is the proof of delivery. Healthcare providers need to submit the delivery receipts and signatures for completion of documentation. It helps in guaranteeing compliance and claims submissions.
Frequently needed extra documentation consists of:
- A detailed written order (DWO), signed by the prescribing physician, details the item, length, diagnosis, and reason.
- Face-to-Face Encounter Note: A clinician is required to record a patient visit within six months of ordering specific DME for many Medicare claims.
- Advance Beneficiary Notice (ABN): Notifies patients that if the equipment is not covered, they may be held financially liable.
2. Coding for HCPCS in DME
DME billing depends on accurate coding. For billing purposes, DME is identified and categorized using the Healthcare Common Procedure Coding System (HCPCS).
An explanation of HCPCS codes:
HCPCS codes are alphanumeric codes that stand for certain medical treatments, equipment, and services. There are two types of categories for HCPCS codes; Level 1 codes and level II codes. Level II codes cover DME while level while level I codes cover CPT codes.
Common DME Code Examples:
E0900: Manual, conventional wheelchair
E0424: Stationary oxygen concentrator
E0260: Semi-electric hospital bed
Typical DME Billing Modifiers:
- NU: New Equipment
- RR: Rental
- Used Equipment, or UE
- KX: The necessary paperwork satisfies medical necessity and is on file.
- GA: Liability waiver on file (used when signing an ABN)
- GY: The item does not satisfy Medicare requirements or is statutorily excluded.
Correct use of these is essential for audit compliance and claim acceptance.
Typical Billing Situations with Modifiers
E1130 RR (rental, three months) is used in the initial claim of wheelchair. After surgery, a patient needs a manual wheelchair.
With proof of medical necessity and in-person examination, the provider bills E1130 NU (new purchase) following the rental period.
Example 2: KX Documentation with CPAP
The patient is given a CPAP after being diagnosed with sleep apnea.
Bill with E0601 NU KX to show new equipment and that all paperwork (including DWO and sleep study findings) is on file.
3. The Procedure for Filing Claims
One of the most important steps in DME billing is the claims submission procedure, which calls for strict adherence to rules and close attention to detail.
The CMS 1500 form, which is the common claim form used by healthcare providers to charge Medicare and other insurance payers, is used to submit the majority of DME claims. The patient, provider, and services provided must be fully described on this form, together with the relevant HCPCS codes.
4. Guaranteeing Adherence
Compliance is a significant component of DME billing. There are particular federal and state rules that providers need to follow. These laws keeps on changing, therefore, providers need to stay up to date to the industry standards.
- HIPAA: Protecting patient information when processing claims
- Stark Law: Preventing doctors with financial interests from self-referrals for DME
- Incentives for referring DME services are prohibited by the Anti-Kickback Statute.
- Regular internal audits and continual employee training assist find mistakes and maintain your process in compliance with changing regulations.
Your Perfect DME Billing Partner: SwiftCare Billing
SwiftCare Billing provides extensive DME billing services that are customized to satisfy the particular requirements of medical professionals. We have a professional team that ensures accurate billing and coding according to the industry standards.
If you are looking for a reliable medical billing company that ensures successful reimbursements, SwiftCare Billing is here to help you.