In the ever evolving landscape of healthcare, every medical equipment provider plays a crucial role in ensuring patients have the right access to the devices they need to maintain their well-being and healthy life. However, managing its billing process is something that most people get anxious about. This is because to facilitate a seamless billing process, providers must grasp the differences between HME (Home Medical Equipment) billing and DME (Durable Medical Equipment) billing.
DME Billing: A brief Overview
DME is a flourishing industry where the market size was valued at USD 59.7 billion in 2022 and is expected to expand at a compound annual growth rate (CAGR) of 5.7% from 2023 to 2030. Also known as Durable Medical Equipment, DME encompasses a wide range of medical devices prescribed by physicians based on the medical needs of patients like – Blood sugar meters, Canes, Commode chairs, Crutches, Continuous Positive Airway Pressure (CPAP) machines and more.
DME primarily focuses or mostly deals with tangible products and is not limited by the location of the use. In fact, to qualify for DME coverage, providers must adhere to lengthy and intricate checklists established by insurance carriers, where the key requirements often include:
- Home Assessment: Providers must conduct a comprehensive home assessment to ensure that the prescribed equipment can be safely used in the patient’s residence.
- Trained Technicians: Trained technicians are responsible for the delivery and assembly of the equipment to guarantee its proper functioning. Etc
Further in the case of managing DME billing the billing team plays a pivotal role here. From verifying insurance coverage, handling necessary documentation, and communicating with insurance carriers on behalf of the patient; a biller has to take care of it all. it does not end here, a biller has to handle the intricate back-office process that often involves training employees, resolving claims disputes, challenging incorrect reimbursements, and correcting billing errors. Also, understanding that the Medicare coverage for DME necessitates a face-to-face office visit with a primary care provider (PCP) who must sign an order, prescription, or certificate. The prescription must state the medical necessity of the equipment and its intended use at home. Additionally, the office visit should occur no more than six months before the prescription is written.
So handling DME billing is not as easy as it is seen.
HME Billing: Understanding the Distinctions –
Home Medical Equipment or commonly known as HME specifically caters to medical equipment suitable for home usage and can be managed by the patient or a non-professional caregiver; like – Catheter, Apnea monitor, Bedpan etc. the global HME market in fact is estimated to reach $56,457.87 million by 2027, registering a CAGR of 6.1% from 2020 to 2027.
Compared to DME billing, HME billing presents unique challenges as a provider need to establish efficient internal communication channels to meet patient needs, complete surveys, and obtain accreditations and FDA licensure for certain equipment, such as oxygen supplies.
Furthermore today the HME services are expanding, incorporating professionals like physical therapists, dieticians, nurses for in-home visits, diabetic counselors, and respiratory therapists. This diversification adds complexity to the billing process, demanding extensive training and experience from billing experts to ensure accurate and timely reimbursements. in fact, this is also the reason why today most providers are looking for alternative options like outsourcing.
The Need for Outsourcing in Complex Billing Structures
As the DME and HME are industries with a huge demand, it often becomes confusing and difficult for many providers to match their billing needs. This is why for many DME and HME providers turning to outsourcing solutions in order to better allocate their resources. in short, by partnering with specialized medical billing experts, providers can not only ensure a streamlined and efficient reimbursement process but also get chances and time to focus on delivering high-quality patient care.
Sunknowledge understanding your DME and HME billing needs:
Understanding the nuances between HME billing and DME billing and establishing a robust billing system, Sunknowledge Services Inc has been alleviating the burden of HME billing for many leading names in the industry.
Navigating the complex billing structures, reducing the overall operational expenses and with constant follow-up and checks and balances, Sunknowledge is known for delivering the highest productivity metrics in the industry.
Looking for more information on how Sunknowledge can help, call the expert to know better. Helping you to concentrate on your primary goal – Sunknowledge is here to deliver exceptional healthcare services to those in need.
