ICD-10 and DME Billing- Does Outsourcing Spell More Revenue?

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ICD-10 and DME Billing

DME billing is the process of submitting and receiving payment for a claim from the insurance company. Implementing, maintaining, and educating staff on proper billing is vital to a DME provider’s success. The challenges facing Durable Medical Equipment (DME) organizations with the upcoming ICD-10 coding system are plenty. Although the DME you bill for will still employ the same HCPCS codes, the actual difference will be in the diagnosis coding itself.

• Firstly, the transition from ICD-9 to the new ICD-10 coding system has led to an increase in the number of codes for procedures from 3,824 to 71,924 and simultaneously has also increased the number of codes for diagnosis from 14,025 to 69,823.
• Secondly, there are few one-to-one, cross-walked codes in the ICD-10
• Thirdly, it is a known fact that the DME providers receive meager information from the physician to convert the codes accurately thus leading to delays in claims causing a shortage in cash flow.
• Fourthly, reimbursement of DME incidents needs to establish the necessity of a DME device within a treatment episode and the knowledge of the device that covers it. More accurate identification of the treatment episode that makes the use of the device eligible for reimbursement is now more than ever required

Fifthly, software updates are required, and the capital investment will increase given the training of the staff. Moreover, the labor-intensive work like handling dual code sets much after the October 1 2015 deadline until all is ironed out, the change in business documents like contracts, bills, training and operation documents, etc. associated with ICD-9 codes will all need to be updated.