Frequently Asked Questions

Is it important for a DME provider to choose a billing service that specializes in Durable Medical Equipment (DME) billing?

 

Yes, a high degree of specialization is required in the billing industry today due to the ever-increasing complexity of criteria and regulations.

 

Would reducing claims errors cut reimbursement time for my organization?

 

Absolutely. An experienced and qualified billing service like DME Claim Services will identify erred claims and correct them prior to submission, get confirmation that each payer received your claims, and prevent input errors at the payer level.

 

Does your service include electronic claims submission capabilities? If not, are there additional costs to add this software component?

 

Yes, it does. There is no additional charge for electronic billing.

 

How many and what type of claims do you file to payers each month?

 

Over 3,600 DME claims per month to Medicare, Medicaid, Blue Cross, and all other payers.

 

Is staff available to assist with the medical policy and regulatory questions?

 

Yes, we feel it is very important to keep our clients informed of medical criteria and to assist them with coding, medical policy and fee schedule issues.

 

Are the fees paid monthly or on a per claim basis?

 

Fees are on a percentage basis and are billed out the month after the provider has received payments.

 

Are there processes in place to ensure the use of current codes (i.e., CPT, HCPCS, CDT, ICD-9-CM, ICD-10-CM and NDC) ?

 

We utilize professional coding software that is continuously updated with current codes.

 

Are our contracts, systems and procedures compliant with the Health Insurance Portability and Accountability Act (HIPAA) requirements?

 

Yes

 

Will we forward important vendor and/or payer communications?

 

We review list serve information from CMS, the four DME MAC Jurisdictions, and other payer organizations, and forward important updates to our clients.

Are there any claim-types that you will need to submit to the payer on paper?

 

There are a few payers that still do not accept electronic claims.  Those are billed on a properly completed CMS 1500 claim form, and mailed or faxed to the payer. 

Why are electronic claims faster?

When Medicare receives a paper claim, they are required to wait at least 28 days before paying. For an electronic claim, the minimum waiting time is 13 days. By filing a "clean claim" electronically, your turnaround time is improved by two weeks. With very few exceptions, Medicare no longer accepts paper claims.

What about Blue Cross and other commercial insurance?

It’s no secret that an efficient electronic billing process increases cash flow and yields higher claims acceptance rates. Electronic billing through our clearinghouse provides fast confirmation of received claims and immediate identification of eligibility or coverage issues.

What is a "clean claim?"

A "clean claim" is one that has all required data, such as valid diagnosis and procedure codes, plus any required documentation such as Certificates of Medical Necessity.

How long will it take to receive payments on claims?

A "clean claim" to Medicare takes about two weeks.  Medicaid varies greatly from state to state, and commercial claims average about 15 to 30 days. Patient billings average 30 to 60 days.

What does it cost?

We normally charge a percentage of the payments we generate for you. For more information, please contact us at (317) 826-0111 x107 or toll-free at (888) 569-3017 or complete our information request form.

Does our company need to buy any software?

The client is not required to purchase any computer software or equipment. Our system is a complete electronic billing and A/R package for DME.

As a client, what information do I need to provide for processing of medical claims?

You will need to provide DME Claim Services Corporation with the Provider EIN number, NPI, NSC and Medicaid provider numbers as well as the appropriate provider information for the HMO's and/or Provider Networks, in which you participate, so that we will have accurate billing information. There are also a few forms to sign to authorize us to transmit claims on your behalf.

You are also responsible for providing appropriate patient demographic information, including insurance ID numbers, diagnoses, items and dates of service.

Anything else I should know?

We stay up-to-date on changes in the healthcare insurance industry, and we inform our clients as we become aware of changes that affect their business. We help our clients maintain compliance by alerting them if we see problems in documentation or CMN completion and by informing them if they need to refund a payment for any reason such as a duplicate payment.

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