Durable Medical Equipment - Healthcare

DME in Medical Billing

Channagangaiah
What is DME in Medical Billing?

DME means Durable Medical Equipment.

Medical equipment’s that are utilized by the provider in treatment of the procedure or it’s prescribed by the provider to the patient, which is appropriate to use in the home and helps to boost patient’s daily activities.

It means DME is principally used to help in for a medical purpose, can endure for repeated use and suitable to use in the home.

For samples of Durable Medical Equipment is:

Wheelchair, Walker, Hospital beds, CPAP devices, Oxygen equipment, Nebulizers, Blood testing strips, Commode Chairs, Crutches, Medical supplies and so on.

Important Note:

  • DME requires a prescription to either rent or purchase the equipment.
  • Authorization is required from insurances for a few of the Durable Medical Equipment’s and it varies from insurance to insurance.
  • Medicare insurance as secondary won’t pay for the rental items. It means Medicare insurance as secondary they pay just for the purchased items.

 

What modifiers used in billing DME Claims?

Let us see some of the important and frequently used modifier we come upon while billing DME in medical billing:

KX modifier is used to indicate required documentation is on file to support the medical necessity of the item.

RT – Right side

LT – Left side

If the item is rented from the beneficiary, then below modifier are used:

RR modifier is used to indicate rental equipment.

Along with the RR modifier we used any one of the below modifier to identify the month of the rental item billed:

  • 1st Month of the rental item is indicated by using KH Modifier
  • 2nd and 3rd month of the rental item is indicated by using KI Modifier and
  • 4th to 13th month of the rental item is indicated by using KJ modifier.

If the item is purchased from the beneficiary, then below modifier are used:

NU modifier is used to indicate Purchase of new equipment

UE modifier is used to indicate purchase of used equipment

 

What documentation supplier must have on file in order for insurance to reimburse the DME Claims?
  • Physician Written order form:

DME written order needs to have detailed description of the item signed and dated by physician. Also it should have beneficiary name with complete address.

  • Maintain Proof of Delivery Documentation:

It is a signature on the order form (Proof of Delivery) along with the date from the beneficiary, which states beneficiary received the ordered item and also it determines the DME carrier to pay the amount to the DME supplier.

  • Certification of Medically Necessity (CMN)

Certain DME equipment require CMN form from a doctor to support the medically necessity of the item to a beneficiary in order to reimburse the claim for DME supplier.

 

What are the fore most DME denials in Medical Billing?

The most DME denials in Medical billing are as follows:

  • Procedure is inconsistent with the modifier.
  • The date of death is before the date of service.
  • Lifetime benefit maximum has been reached/ billing exceeds the rental months covered / Payment cannot be made after the reasonable purchase price has been met.
  • This service isn’t covered since our records show that the beneficiary was in the hospital/SNF on the date of service billed.
  • No certificate of Medical necessity received.
  • The modifier that indicates what rental month you are billing does not match what we have on file.