DME or Durable Medical Equipment is any equipment that provides therapeutic benefits to a member because of certain medical conditions and/or illnesses, can withstand repeated use, is primarily and customarily used to serve a medical purpose and is appropriate for use in home.
Providing DME billing services, often referred to as Home Medical Equipment (HME) billing services, can be a time-consuming and tiresome job. It requires in-depth knowledge of reimbursement guidelines of Medicare, Medicaid and Commercial Plans, and their requirement.
At GoTelecare, our experience shows that the process for DME billing can be a complex and lengthy affair. Right from the point where the order gets generated from a physician’s office, to the realization of the full payment – there are many steps to be covered. This increases complications and the turn-around time as dependencies increase. Payer guidelines are specific to diagnosis. Therefore, a close familiarity with them results in reducing denials considerably.
Our meticulous physician and payer 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 zero balance. It covers eligibility checks, authorization processes, creating sales orders, scheduling delivery, submitting claims, managing rejections and denials, and proactively following-up AR.
There are plenty of good reasons to outsource your DME billing to GoTelecare, but the biggest one is setting yourself free to do what you do best viz. serve your patients more and worry less about billing matters. We work with you so you don’t have to spend your precious time on tedious billing, maintaining regulatory compliance, practicing management and doing the accounting.
Order Entry – Patient information (demographics & insurance), Ordering physician, Prescription & Diagnosis
Eligibility / Insurance Verification
Follow-up on medical documentation collection
Follow-up on authorization approval
Creation of sales order
Creation of service estimate (patient financial responsibility)
Printing / intimation of ready for delivery tickets
Confirmation (audit) of order on receipt of proof of delivery
Submission of claims (EDI / Paper)
CPAP User Compliance Tracking
Counseling calls to non-compliant CPAP users