COVID-19 had an ongoing impact with the implementation of the new round of Medicare’s Competitive Bidding Program. The year 2021 has seen unprecedented acquisitions and mergers to overcome the pandemic’s obstacles. Not only that but numerous industries, including the medical sector, have been plagued by compliance issues. All of this has had an impact on the billing services for Durable Medical Equipment (DME). Without a doubt, the constant changes in regulatory compliance have already made it difficult for DME providers to stay current. On the other hand, the DME medical billing and coding system will see even more additions and changes in 2022.
Hence, it is important to stay informed about the changes that can be expected to provide better patient care. It will also help to avoid mistakes while making the DME billing process more cost-effective.
Continuous Glucose Monitors
The Centers for Medicare & Medicaid Services (CMS) issued a rule effective from February 28, 2022. Non-implantable continuous glucose monitors have been classified as DME. This regulation is made regardless of whether the FDA approves CMG to replace the blood glucose monitor used in diabetes treatment decisions.
Indeed, any CGMs that do not replace the blood glucose monitor will be considered adjunct DMEs and must be billed for. These can be used to monitor the patient’s glucose level even while they are sleeping. Furthermore, it can be used to detect potentially dangerous levels of glucose in the patient.
Changes to CGM Receivers’ Codes and Modifier
The HSPCS codes and modifier combinations used to bill rental insulin pumps used as non-adjunctive CGM receivers have changed. Furthermore, the changes differ for claims based on the service date. For example, the codes for February 28, 2022, and March 31, 2022, differ from claims dated on or after April 1, 2022.
There is also a change in the billing for the beneficiary and their coverage. For example, until the insulin pump, or CGM, is used for five years or expires, the new regulation will not cover it.
Undoubtedly, only two changes for CGM receivers. Many more are in the works or are scheduled to be implemented, such as a full-scale investigation into illegal telemedicine prescribers. As a result, it is beneficial to plan ahead of time and implement some strategies for 2022 to ensure efficient DME billing.
Strategies to Implement in 2022 for Efficient DME Billing
Because changes in DME are obvious, it is preferable to have some strategies in place to deal with such changes. So, here are the top five strategies you can follow:
Understand the Changes and the Process
DME billing is different from other types of medical billing and coding services. Firstly, it is time-consuming and requires the completion of proper paperwork involving doctors, DME suppliers, and insurers. As a result, proper DME billing and coding are required, for which the patient’s prescription, as well as the patient’s insurance policy and billing information, are required.
Pre-authorization may be required by the patient to process the claim at times. Furthermore, the insurance company will verify the diagnosis and treatment before approving the equipment and billing. As a result, every step must be understood and kept up to date with changes to ensure the claim is successful.
Validating the Insurance
Validating the insurance by either calling them and knowing the detail about the patient’s coverage or using EMR for verification before the scheduled appointment will give you the time to understand the information on the patient’s policy. In addition, it will allow you to know whether the insurance covers the equipment, thus preventing late or no payment.
To ensure accurate and timely DME billing and claim management, you should not emphasize only on above strategies. You have to ensure that every piece of equipment and accessory is coded and billed correctly for the claim to be successful with the insurer. Therefore, every staff handling the DME coding must keep track of the ICD-10-CM, HSPCS, and CPT-4 coding.
Validating the insurance beforehand will also allow you to collect the amount if there are any co-payment or co-insurance clauses. There is a need to put in place an efficient check-out process while the patients are on-premises. It must also include checking any deductibles and past dues timely.
Better AR Management
Apart from ensuring proper documentation and staying on top of regulatory changes, effective AR management is another way to ensure a longer DME revenue cycle with all of the changes.
It is critical to update the system with the most recent AR applications that are equipped with changes for the healthcare industry. It must also be updated based on the EMR for patient data, follow-ups, reimbursements, and claims. As a result, this procedure will aid in the automation of collection and the streamlining of the DME billing system.
How Can You Ensure You’re Ready for Changes?
DME billing necessarily involves a thorough understanding of the process as well as keeping up with constant changes, follow-ups, and other claim management issues. As a result, outsourcing DME billing services is one of the best ways to move forward with claims. The entire team of experts at Zee Medical Billing Services stays up to date on all changes, regulations, and rules to ensure that A/R collection is processed and managed efficiently. While you focus on your patients, outsourced DME billing experts will ensure that you receive reimbursements without delay.
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