Tips to Streamline your DME Billing Process

Proposed Rule by CMS

In 2019, CMS released the proposed rule that included potential changes to the DME payment rates. This long-awaited proposed rule is being considered positive because it includes vital improvements for payment in non-bid areas along with improvements to the CBP (Competitive Bidding Program).

The DMEPOS fee schedule has been updated by the CMS and several new codes have been added to the HCPCS file. For instance, DMEPOS fee schedule file includes fees for three home infusion G-codes - G0068, G0069 and G-0070. For other new CY2019 codes, the fee schedule amounts will be established under DMEPOS fee schedule update.

Fees have also been added for new HCPCS code (E0467). Fee schedule amounts are also being adjusted for shoe medication codes and mail order DTS. For CY2019, update factor of 2.3% has been applied to few DMEPOS fee schedule amounts. CMS is also implementing monthly fee schedule payment amounts for stationary oxygen equipment.

It has been published by the CMS in order to drive innovation in DME and also to modernize it. Here are some of the highlights of this proposed rule:

•      Starting and until CBP contracts are awarded, it has been proposed that the beneficiaries will be receiving DME items from any Medicare enrolled DME supplier.

•      For DME furnished, CMS has proposed traditional fee schedule amounts.

•      For non-CBAs that are non-contiguous or rural areas, items furnished will be paid at 50/50 rates and for non-CBAs; items furnished will be paid at current payment rates.

•      CMS has proposed new payment classes for portable oxygen and oxygen equipment, new payment rules for ventilators and has improved payment rates for new DMEPOS items.

DME coders will have to be prepared for coding changes coming their way. For DME providers, the only way to survive 2020 will be through hiring experienced coders or by letting an reliable third party handle the challenges of DME billing. 

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