Medical Billing for DME is a lot more misunderstood than any other billing process. In fact Harvard Business study HBS.443rt showed that roughly 90% of all pharmacies have little to no experience in regards to codes and or forms relevant to Medical billing for DME process and or forms. The contract business model that is so relevant today DMEs are being required to have contracts more so now than ever in order to do business so this is becoming a great hurdle to step over for new startups, this is why it was imperative for Infallibill to hire staff that understand the differences between billing out pharmacy codes and DME codes.


The amount of work loads that come with DME billing can literally stress even the most organized practice. Pharmacies rely heavily on a three part system 1) Receive the prescription from practitioner, load up patient data and then check to see distribution payments from the drug. Pharmacies have full control of the payment and do not even have to release the prescription unless the payment is to their liking. For DME’s billing is quite different in that they have to submit a claim for every single patient they provide product to. Making it quite difficult to manage their receivables and workflow.   


It should be common practice for pharmacies to have a good working knowledge of DME billing in general but definitely around reimbursements. Infallibill’s inhouse analyst’s always have new philosophies when it comes to decisions on what DME products are trending around billing and engaging with our pharmacy clients we always share that data and our recommendations. Part of the reason that we typically are ahead of the curve when it comes down to picking and choosing DME products is we always analyze the medicare laws. Number one its free information, Local Coverage is simply found in the Supplier Manual and anyone willing to spend time in research can put a majority of the puzzle together. Infallibill uses software for a reason, one of those reasons is we started as a software company and number two software can handle the constantly changing updates and new product codes without the software.  There are many specific DME billing challenges in encountered by most pharmacies and believe it or not most can be avoided.


The number one reason most pharmacies have DME billing challenges revolves around the follow up. Typically the rate of reimbursement and the turnaround time of each claim are both increased by 33% just due to proper follow up. A lot of practices can fill out forms and bill, not so for DME billing.


Electronic Claim solutions are key to successful billing integrating new DME billing into pharmacies existing billing systems is a serious problem and aligning the separate billing structures rental equipment and combining two billing systems is unorganized unless properly systemized on a single platform for clinical, billing and reporting (usually cloud based the better). Infallibill’s team of experts is happy to integrate systems, consult and or just completely turn key handle any and all of your Workflows let us know today what your struggles are and tomorrow we can start realizing your goals.


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