How to bill for DME ( medical equipment)? What are the billing codes for each medical equipment? How to bill for medical supplies?

This can be a stressful task. Billing and knowing all the bill codes (HCPCS codes) for each individual medical item can be overwhelming because there are over 500 codes in the medical equipment field. We will teach you the specific codes you will be billing and give you each bill amount for each HCPCS code.

How do I know what allowable amounts to bill for medical supplies?

Many healthcare insurances have their own allowable amounts. Allowable amount means the allowed amount they will reimburse you for each medical equipment you will be billing for. We will give you the knowledge on how to bill within the allowable amounts.

How do I look up the Medicare allowable amounts for DME medical supplies and equipment? How much does Medicare pay for medical supplies I want to bill for? How do I know if Medicare will pay on a purchase or on a rental for medical supplies and equipment?

Medicare has their own allowable amounts that they will reimburse you for each medical supplies you want to bill. Once you have established a Medicare accreditation, we will give you the knowledge on how to bill Medicare with each allowable amounts weather it be on a purchase or on a rental.

How can I get more medical supply orders from clinics or physicians?

This question is often asked by many of our clients. There are ways to market out your DME business within your city or online with website presence. Remember that when you open any business, location plays a big part of how well your business thrives within a city. It’s also known and said as, “location location location”.

How much money or capital do I need to get a medical supply business started?

This all depends on your own financial availability. Like with any business, you have to have a good capital to start with. If you are looking into getting a location and building a DME store front (brick and mortar) you will need a good amount of capital to buy equipment, furnish your store, monthly rent, ect… If you are looking into building a website and only want to sale DME products online you will also need to create a good domain name that is marketable within the DME field. A domain name is like choosing a location for your store front. We recommend a branding manager that will build you a good website along with a web based store so you can take advantage of the world wide web and reach a larger audience that is looking for medical equipment/ supplies.

We have an entire data base of DME names and DME websites for sale. These DME names and websites are part of our marketing and branding package. Please contact us for more details

How do I bill for medical supplies and equipment in my state?

If you are billing for medical equipment to PPO insurances, you will need to know all the billing codes that pertain to each medical equipment you want to bill for. Each insurance has their allowable bill amounts and you will need to abide by their allowable amounts. Our consultant will guide you in learning all the bill codes so you can effectively bill the correct codes.

I am a current provider (Chiropractor, Physician, Physical Therapist, Pharmacist, Respiratory Therapist, Registered Nurse, LVN) Can I add DME to my practice or start a medical supply business?

Yes you can! Since you already know the healthcare industry you will fall right into the DME industry easily. You can service your patients with all kinds of medical supplies and offer more services. The more services you offer in your clinic, the better patient outcome you’ll have! You can dispense DME to your patients right from your facility. You’ll need staff to handle this department for you and we can train your staff on how to effectively proceed with billing and deliver DME to your patients. Adding DME to your already existing clinic can generate more profits for you instead of out sourcing your DME orders to another company. Keep it all in house!

How do I get a medical supplier license in my state?

Every state has their own rules and regulations for a DME medical supplies license.

The regulation of businesses providing Durable Medical Equipment (DME) or Home Medical Equipment (HME) is dependent upon the types of equipment, as well as the jurisdiction. Since the term DME covers a wide array of devices, from crutches to catheters to wheelchairs to blood glucose monitors, it may not always be clear for businesses whether they must be licensed in a particular state. Additional permitting may be required for certain types of equipment (e.g. a Pharmacy License for oxygen-related devices). Start DME, LLC will streamline the process of determining and obtaining the proper DME licenses for your DME business. We provide comprehensive research regarding Durable Medical Equipment (DME) license requirements, and we prepare error-free application packets, minimizing time-consuming and costly delays.

DME suppliers are governed by stringent federal and state laws, particularly those that participate in the Medicare/Medicaid program. Initially, if a license is determined to be required, a DME company must obtain an “in-state” or a “resident” license. This generally requires an extensive application, varying fees, proof of insurance, and an inspection, which is usually scheduled upon approval of the application. If the company wishes to expand into another state, it must obtain an “out-of-state” or a “non-resident” license in that state. This process is more of the same, but also may require verification that the business currently holds a resident license (or proof that a license is not required) in the home state.

DME providers include DME companies, home health agencies, physicians, and other practitioners. The fact that you are a licensed home health agency or physician/practitioner does not exempt you from DME licensure. The State Board of Pharmacy of Department of Health generally issues licenses.

Ramifications of Non-Compliance

A company providing Durable/Home Medical Equipment without proper DME licenses may be subject to civil and criminal penalties. Companies must be particularly careful to ensure that their employees are properly licensed if they are going to be setting up or installing any of the equipment being provided. In many cases, companies have incurred heavy fines as a result of unlicensed employees.

How we help your business:

1. We stay up-to-date with changing requirements and forms so you can focus on the job at hand.

2. We complete license applications efficiently and correctly, allowing your in-house staff to save valuable time struggling to obtain the proper DME licenses.

3. Once your license has been issued, we ensure that you remain compliant with all DME licensing laws.

   Medicare Enrollment Process

   Provider Enrollment Review Process

   Institutional providers that are initially enrolling in Medicare, adding a practice location, or revalidating their enrollment information per 42 CFR §424.515, are required to submit an application fee. If using Internet-based PECOS to submit your CMS-855A enrollment application, the fee is paid as part of that process. If you submit a paper CMS-855A application, the application fee is paid on the Centers for Medicare & Medicaid Services (CMS) website.

   For paper applications, if the fee is paid before the application is submitted, please include a copy of the payment confirmation with your application.

   Fingerprint-Based Background Checks

   Fingerprint-based background checks are generally completed on individuals with a 5 percent or greater ownership interest in a provider or supplier that falls under the high risk category. A 5 percent or greater owner includes any individual that has any partnership in a high risk provide or supplier.

   NOTE: The high level of risk category applies to home health agencies who submit an initial enrollment application. As a result, this request may delay the processing of home health initial applications.

   Process Timeline

   CMS-855A applications are typically completed within 45-60 calendar days from receipt. Extenuating circumstances may extend these time frames. The following summarized the review process.

   • Within 3-10 days after receipt of an enrollment application, CGS will issue an acknowledgement letter with a reference number.

     • Enter the reference number on the CGS Application Status Check tool on the CGS website to check the status of your application.

   • Within 15-20 days after receipt of an enrollment application, a development letter will be issued if additional information is needed.

     • An email is the preferred method of communication. Additional information will be requested via email to the contact person listed in Section 13 of the CMS-855A.

     • Additional information must be submitted within 30 days from the request. Tips to avoid rejection due to not providing information timely include:

       • CGS is only required to contact the provider one time; therefore, it is important that you respond as soon as possible. This will allow more time for CGS to work with providers to complete the application.

       • Address all information requested

       • Call if you have questions about what is being requested. The contact information is included in the letter or email.

       • If a development letter is sent, submit a copy of the development letter with the requested information to ensure it is matched with the correct record.

   • Tips to decrease the typical completion time:

     • Clean applications are processed quicker

     • Faster response to development request

     • Review the Most Common Reasons for Delays in Application Processing Web page

   Note: If requested information is not received, or is incomplete, the application will be rejected and a 855A application must be submitted.

   Initial Enrollment

   Once the application review is complete, CGS will send a letter of the recommendation (approval or denial) to the provider, State Agency, and the CMS Regional Office (RO).

   • If approved, the State Agency and the CMS Regional Office (RO) will complete the survey process and issue the Medicare provider number. Contact information is provided in the recommendation letter. This allows you to follow-up with the state or RO on the status of the provider number assignment. The process for completing the survey and issue the final determination via a CMS-2007 certification notice (also known as a Tie-In Notice) can take up to 6-9 months.

   Note: CGS does not take any further action on the initial application until the tie-in notice is received.

   In addition, some provider types may require a site visit once the tie-in notice is received. As a result, if any information on the initial enrollment changes, providers are required to submit updates.

   It is the applicant's responsibility to submit the CMS-855A enrollment application information timely and in accordance with CMS requirements. Applications are processed in the order of receipt, and CGS cannot accommodate requests to expedite the review process.

   Provider Enrollment Development Requests via Email

   CGS has introduced sending development requests via email. If you are a contact person identified for an 855 and/or 588 EFT Application, please provide a valid, legible email address within the Contact Person section. If your application requires additional information, you will receive Provider Enrollment correspondence regarding your application, from J15.PROVIDER.ENROLLMENT@cgsadmin.com. This email account is only monitored for corrections to applications in process. Any emails received that are confirming receipt of your email or general inquiries cannot be addressed as this email box is automated.

   We encourage you to respond to the development requests using email. When replying, please reply ALL and do not forward. Please do not alter the subject line or recipients. Simply add your comments and attachments to the email and send to ensure efficient and timely handling. If you choose to submit the requested information via email, you do not need to also fax and/or mail an additional copy. This adds time to processing. Please be mindful that if the letter identifies a request for a complete application or an original signature, these should be mailed to our office at the address identified within the letter.