What is the Medicare Dme Fee Schedule?

Let’s start with the basics. The Medicare DME Fee Schedule is a list of maximum fees that Medicare will pay for Durable Medical Equipment (DME) items and services. When a Medicare beneficiary needs DME, they can obtain it from a Medicare-approved supplier. The supplier then bills Medicare directly for the cost of the equipment or service, up to the maximum fee allowed under the fee schedule.

The Medicare DME Fee Schedule is updated every year by the Centers for Medicare and Medicaid Services (CMS) to reflect changes in the cost of living and inflation. Because the schedule changes so frequently, keeping up-to-date on the details can be tricky.

What You Should Know About the Medicare DME Fee Schedule

It’s vital for DME Suppliers to be as familiar with the current Medicare DME Fee Schedule as possible. By understanding the schedule and staying up-to-date on any updates or changes, you can better ensure that you’re billing appropriately for the provided services and equipment.

Here are some of the most important things for a DME provider to know about the ever-changing fee schedule:

Maximum Allowable Fee

The fee schedule sets the maximum amount that Medicare will pay for DME items and services. DME providers like you should take great care to ensure they’re billing an appropriate usual and customary charge price to ensure full reimbursement.

Geographic Adjustments

The fee schedule is adjusted based on the geographic area in which the beneficiary resides. Suppliers should regularly check the specifics of the Medicare DME Fee Schedule for the location of the beneficiary  to ensure the proper amount is being billed.

Coverage Criteria

Medicare has specific coverage criteria for DME items and services, and in order for Medicare to pay for a particular item, the beneficiary must meet those criteria. It’s vital that your team stays familiar with the current coverage criteria to ensure that all provided DME is eligible for reimbursement.

Competitive Bidding

Medicare uses a competitive bidding process to determine the fees for specific DME items and services in certain areas. You’ll want to do your research to stay aware of how the competitive bidding process may affect your fees and ability to provide certain items.

Annual Updates

The fee schedule is updated annually to reflect changes in the cost of living and inflation. It’s crucial for DME providers to stay up-to-date on changes to the schedule to ensure their billing practices continue to produce the best results.

How Medbill Can Help You Stay Up-to-Date

A third-party medical billing service can be an extremely valuable resource for DME providers who need assistance when it comes to the Medicare DME Fee Schedule. Here are some ways Medbill can help your company navigate it:

1. Ensuring accurate billing

Medbill offers a team of experts in billing and coding for DME services. We’ll ensure that your company is billing accurately and within the allotted fee schedule amounts to avoid any issues with improper billing or reimbursement.

2. Staying up-to-date on fee schedule changes

The Medicare DME Fee Schedule is updated annually, and it’s important for DME providers to stay up-to-date on any changes. Medbill can help you to keep abreast of any fee schedule changes and ensure you continue to bill for accurate amounts.

3. Maximizing reimbursement

Medbill can help you maximize your reimbursement by ensuring all DME provisions are properly documented and correctly billed. We’ll also identify any underpayments or denials and work to resolve them swiftly on your behalf.

4. Providing compliance support

Medicare has highly specific coverage criteria for DME items and services, and it’s essential to make sure those criteria are met. Medbill can provide compliance support to ensure your company avoids any potential issues with billing.

Navigate the Medicare DME Fee Schedule with Medbill

If this sounds like a lot of information, that’s because it is. The Medicare DME Fee Schedule is a complex system with a wide variety of contributing factors. Luckily, your company doesn’t have to navigate it alone. With the help of Medbill, your company can bill with confidence today and for years to come.

Contact Medbill today to see how we can benefit your DME supply business.

For more information regarding the Medicare DME Fee Schedule, visit CMS.GOV.

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