Understanding and Guidelines for Your Durable Medical Equipment Billing

Table of Contents

What is Durable Medical Equipment (DME)

Durable medical equipment is any equipment used in the home to aid in a better quality of life. In some cases, certain Medicare benefits, that is, whether Medicare may pay for the item. A healthcare specialist orders equipment and supplies for everyday or extended use. Coverage for DME may include oxygen equipment, wheelchairs, crutches, or blood testing strips for people with diabetes. A Durable Medical Equipment (DME) business is a firm or organization that deals in healthcare items intended for use in the hospital, home, clinics, and for an extended period.

Detailed Instructions & Guide for DME Billing

This article will discuss all the steps required to enhance your DME billing and boost your collection with accurate claims submissions.

Step 1: Get the Required Documents

To obtain successful DME billing results, you must need to review, analyze and secure the following documents;

  • Medical Prescriptions – An official order from a health care provider indicates the DME’s needs to treat the patient. For example, if a patient is diagnosed with a sleep apnea disorder, he is possibly recommended CPAP therapy given by the CPAP machine.
  • Prior authorization – A healthcare provider must determine if the patient is approved for DME from Medicare before issuing the order. This is because the Centers for Medicare and Medicaid Services (CMS) made it a prerequisite in May 2014 to authorize such DME needs for a later DME claim. This also applies to the machines involved in CPAP therapies. This need is targeted to ensure that CMS will not pay for the device and equipment that are not necessarily required medically.
  • Certificate of medical necessity – a medically approved form that shows the medical need and the requirement of a DME, which will be used to prevent certain diseases. Also, it must be filled by the patient’s physician and signed by both physician and the DME provider.
  • Proof of delivery – Before COVID-19, a signed delivery slip was only required to prove the DME delivery. But to prevent the spread of the virus, CMS waived this requirement in March 2020. Afterward, a photo of the recipient and the DME is accepted as proof of delivery.

Step 2: Verifying the eligibility of patient insurance

In the next step, a DME provider confirms the information and details from the insurance company that the patient provided while filling out the DME form. The information includes the coverage in the patient’s insurance and the type of insurance they have. Other information that might be required is the insurance group plan and the policy number.

Step 3: Generate the invoice

Once the necessary authorization has been taken and verified, the DME provider can make an invoice. The invoice should be appropriately processed, ensuring that every DME code is efficiently added according to the latest guidelines provided by the HCPCS (Healthcare Common Procedure Coding System). When it comes to CPAP machines from the DME provider, the invoice will be processed for the CPAP machine and everything that comes with it, like mask and tube, etc.

Step 4: Filing the claim

According to the ASCA (Administrative Simplification Compliance Act), Medicare claims should be filed and submitted electronically. Although, if a DME provider meets specific requirements like less than ten working employees, they can submit the claims through a CMS-1500 paper. Once the claims are submitted either electronically or through CMS-1500 are monitored by Medicare Administrative Contractor (MAC). This process can take no longer than thirty days to be completed.

Other than Medicare and Medicaid, private insurance companies also require medical practitioners to claim reimbursements electronically. For this, DME officials can file their claims directly on the website portal of the insurance provider, or in the case of paper claims, it can be converted into a standard format required at the time of submission.

Step 5: Resubmission of claims

In reimbursement rejections, DME providers can resubmit the claims once the required documents are attached and the necessary amendments are made. However, if the claim satiates all the requirements and the invoice is processed accurately, the claims are likely approved, and payments are released within a few weeks of submitting the claims.


DME billing guidelines must be followed to avoid rejections and a lengthy process of submission of claims. Follow these above steps to ensure your claims get approved timely without creating revenue glitches.

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