Medical Billing Forum

General Category => General Questions => Topic started by: Pay_My_Claims on June 15, 2009, 03:07:03 PM

Title: DME billing
Post by: Pay_My_Claims on June 15, 2009, 03:07:03 PM
I have gotten a couple of emails from members regarding my reference to DME billing. I have done billing for other specialties, but right now my full time job is DME billing and AR. DME is a very broad specialty area. It can range from shoes to high end mobility equipment. I am focusing my billing service on customized DME suppliers. The revenue is very good. The company I work for can see weekly receipts ranging from 0-100,000. On average he brings in about 50k a week. Just one chair can be billed out at $30.000 and bring in around 21,500. We have a client paying out of pocket of $30,000. Imagine your payment!!  So know you want to know the bad part. Well for high-end rehab, there is a lot of documentation required, Medicare has strict guidelines, and you don't have a superbill to work from Yes thats correct, the physician will fax over a RX for the client, the ATS will see him/her they go to a seating clinic, have a face to face, we obtain medical records, a LMN/CMN, send off for Admc approval and oh yeah you have to code each item along with the correct modifiers, and it is usually more than one modifier required. EX: E0630RRKIKX would be used to show a hoyerlift  this is the  2nd or 3rd  month rental and all required documentation is on file. Its not difficult to do, but it does require proper training.
Title: Re: DME billing
Post by: jcbilling on June 17, 2009, 12:18:33 AM
If you don't mind me asking...what kind of percentage do you charge your DME clients? Considering the paperwork & the high dollar amount...I've thought about marketing more to DME Suppliers, but not really sure what rate is reasonable.

Thanks,
Charity
Title: Re: DME billing
Post by: Pay_My_Claims on June 17, 2009, 06:31:50 AM
more of a flat fee billing. 5% for any claims under 10k, flat fee of 1000 for claims over 10k.
Title: Re: DME billing
Post by: Pay_My_Claims on June 17, 2009, 06:55:42 AM
This if for high end custom Rehab billing. Other DME billing carries different fees. Even with custom Rehab if they only have me doing the billing portion, the fee is altered for that. It's higher because of the level of required documentation needed in order to bill for DME. For a provider that brings in 100k a week, he isn't going to pay anyone 5% There has to be some balance.
Title: Re: DME billing
Post by: jcbilling on June 17, 2009, 09:48:57 PM
When you say 5% for 10K, is that for a week of billing or a month? From your example given on 100K, it sounds like a month - just wanted to make sure I understood.

I currently bill for breast prosthesis and charge 4% - probably too low. But I've gotten experience and was just starting in the billing field - so both me & my client were happy!

However, now that I know a little bit more, it's nice to make a decent profit on hard work :)

~ Charity
Title: Re: DME billing
Post by: Pay_My_Claims on June 18, 2009, 07:05:09 AM
No its a per claim basis. If I submit 10 claims and the payment for them is all under 10K, I get 5% off those claims. If I submit 4 claims and payment is 10K+ the flat fee is 1000 per claim. This is only in the case of this provider because his volume of larger claims is small.If I did a flat fee of 5% accross the board, I wouldn't make any money.  In general I base the fee schedule on the estimated revenue. If I have a DME provider that can bring in 100K a week. My percentage can be adjusted so that its financially beneficial to him and me. What you may want to do is look at the volume you have with your provider, look at the time it takes you, and look at how many providers you can do. 4% may be low because you feel you can make more, but if you increase it too much, you can lose a client. My full time provider sends out multiple claims that bring in over 10K so he couldn't afford to pay my fee. For him, he would be a flat fee accross the board of 3% because I know what I could make off a provider such as him, would be very very very nice!!!
Title: Re: DME billing
Post by: Cherylwilli on June 29, 2009, 04:14:45 PM
I'm a newbie and this is my first post.  I have a home based billing service with 3 mental health providers.  I was recently referred to a DME supplier who would like to talk to me about my services.  I'm relatively new to billing and have only done mental health billing--so I find this intimidating, but I'm willing to learn anything.  Can I use my current practice management software (Medisoft) for this or do I need something different.  Can you give me some general information to help me prepare for my call.  Thanks.

Cheryl
Title: Re: DME billing
Post by: Pay_My_Claims on June 29, 2009, 07:46:42 PM
Cheryl
What type of DME provider is he/she. DME is very broad
Title: Re: DME billing
Post by: Cherylwilli on June 30, 2009, 06:33:43 PM
I don't know.  I was given their business card and told to call to discuss billing for them. 

Cheryl
Title: Re: DME billing
Post by: Pay_My_Claims on July 01, 2009, 08:37:07 AM
Google them and find out what type of supplier they are. I work with high end custom rehab (power wheelchairs, hospital beds, manual chairs, standers, hoyer lifts, even work with the adaptive vans). We do other personal care products, but not that much. Some DME providers do just standard power chairs, or manual , or they deal with oxygen, personal care items, etc, so it varies.
Title: Re: DME billing
Post by: margemib on July 03, 2009, 11:42:51 AM
can I ask where did you get your training for this type of billing?
margemib
Title: Re: DME billing
Post by: Pay_My_Claims on July 03, 2009, 11:45:30 AM
I used to sell DME equipment, so I got my initial training from that company, and I eventually worked doing the AR/Billing for one of the largest DME providers in eastern NC.
Title: Re: DME billing
Post by: margemib on July 03, 2009, 12:45:13 PM
what form do you use for this type of billing, is it a cms-1500?
margemib
Title: Re: DME billing
Post by: Pay_My_Claims on July 03, 2009, 02:57:58 PM
yes we bill in the cms-1500. The complexities of DME is often the documentation. Unlike chiro, mental health, or any other specialty field, you don't have superbills. You receive an rx from the physician, verify eligibility benefits (same or similar). New pov, client has to have a face-to-face exam, a LMN ,detailed written order, 7-element Rx, attestation of financial responsibility, home assessment, and be submitted for ADMC approval. A DME provider may want his billing service to obtain that information from beginning to end, thus it will make it more difficult to work several high end DME providers. The difficulty isn't so much in the billing, but the consumption of time to obtain the required documentation for certain DME equipment.
Title: Re: DME billing
Post by: margemib on July 04, 2009, 10:29:17 AM
do you charge a different rate depending on what the supplier wants you to do?
margemib
Title: Re: DME billing
Post by: Pay_My_Claims on July 04, 2009, 01:09:32 PM
do you charge a different rate depending on what the supplier wants you to do?
margemib

Girl yes!!! For instance, you have to depend on the physicians to supply you the information required to submit to Medicare for ADMC approval (except with dx of ALS), and some providers you have to pull teeth to get it done. You only have 45 days from the date of the face to face to have everything stamped and submitted or the client has to do it again.
Title: Re: DME billing
Post by: margemib on July 04, 2009, 02:21:25 PM
with all the info you need I guess you cannot fill this electronically, or can you?
Buy the way I checked out your website, I like it very much it's very professional.
margemib
Title: Re: DME billing
Post by: Pay_My_Claims on July 04, 2009, 04:11:39 PM
with all the info you need I guess you cannot fill this electronically, or can you?
Buy the way I checked out your website, I like it very much it's very professional.
margemib

Yes, you can still file electronically!!! The documentation (Medicare) has to stay on file for 7 years. (but you still must follow your state & federal guidelines for document retention). Once you get ADMC, you just basically submit the claim because they have reviewed the documentation. BCBS is one of the pain insurance companies that will request additional information (Your cost) especially on the K0108 (misc) or the e1399n (unlisted) codes. NC work comp does the same. they only pay 20% over cost (not MSRP) when there is a code not listed on the comp fee schedule. Because I know what they(BCBS) will send back for medical records request (our cost), I will split a claim. I will file electronically what is on the BCBS fee schedule, and the unlisted codes, I will send paper along with our invoice. This way the entire claim isn't held up for documentation. I know the Medicare PFFS plans will request an LMN, so I simply submit them by paper. I can still as stated file electronic, and have them send a request for the LMN and the guarantees the claim is already loaded into the payer system. Also BCBS has the electronic fax back system so the fax is directed back to the requesting person and it helps to expedite things. Yes DME is somewhat slower in some areas, but in others, its just as quick. I have the most difficulty with Medicare (waiting on documentation), the replacements, and BCBS since we are non-par. Most once you get authorization, you are done. Most of the PFFS plans don't require auth, so they will need a LMN or CMN.

Thanks on the compliment on the website.
Title: Re: DME billing
Post by: margemib on July 04, 2009, 05:40:32 PM
WOW you really know your stuff!
Thanks for all the info, it is very interesting.
Have a good rest of your weekend!
margemib :o
Title: Re: DME billing
Post by: Pay_My_Claims on July 04, 2009, 07:04:40 PM
WOW you really know your stuff!
Thanks for all the info, it is very interesting.
Have a good rest of your weekend!
margemib :o

You are more than welcome..I really love what I do!!!
Enjoy your holiday as well  ;D
Title: Re: DME billing
Post by: Charles on July 16, 2009, 05:02:03 PM
Charlene,
Do you know where I can buy a digitized policies and procedures manual?
Thanks
Title: Re: DME billing
Post by: Pay_My_Claims on July 16, 2009, 05:59:37 PM
Charlene,
Do you know where I can buy a digitized policies and procedures manual?
Thanks

I would have to know what you mean by digitized???
Title: RE: Things needed for billing
Post by: marilynclark on October 21, 2009, 06:58:12 PM
What questions would you ask the physician when interviewing for billing services
Title: Re: DME billing
Post by: PMRNC on October 21, 2009, 07:09:23 PM
Quote
What questions would you ask the physician when interviewing for billing services

Why would you interview? Do you mean for a "job" or in terms of marketing?   I don't' have a script, I try to get in and talk with the office manager, biller and provider and let them tell me what problems they have and then I present solutions.
Title: Re: DME billing
Post by: marilynclark on October 21, 2009, 07:55:35 PM
In terms of marketing.
Title: Re: DME billing
Post by: Michele on October 22, 2009, 08:50:25 PM
Like Linda said, try to get them to tell you what problem(s) they have and then focus your 'interview' on that.  If you can fix their problem(s) you are in.

Michele