DME billing means charging for things like hospital beds, wheelchairs, or oxygen machines. These are used by many patients. It is important to bill these items in the right way so money does not get lost.
If billing is done wrong, the claim may get denied or delayed. This can cause big problems for small clinics and big ones too.
This blog will help you learn about the ten most common DME billing mistakes. You will also learn how to stop them fast.
What is this article about?
This article tells you ten DME billing mistakes that happen again and again. It shows how to avoid them step by step. It is easy to read, even for someone new to billing. If you want fewer billing errors and faster payments, this guide will help you today.
1. Wrong billing codes
Each item in DME billing has a code. These codes are called HCPCS and CPT codes. Some are very similar to others.
Using the wrong code can lead to claim rejection or less payment. It can also cause audits from insurance companies.
Check each code two times before sending the claim. Use the newest coding books or billing software for help.
2. Missing medical papers
Every DME item needs proof. This proof is called medical necessity. It shows the item is needed by the patient.
If this paper is missing or not complete, the insurance will deny the claim fast. This causes big delays.
Always keep these papers ready. Attach them with the claim to avoid rejection and problems later.
3. Late claim filing
Each insurance company has a time rule. You must send the claim within a set number of days.
If you miss the deadline, the company will deny your claim. This means you will lose the money.
Use billing tools to track dates. Make sure your team sends claims on time, every single time.
4. No insurance check
Some clinics send bills without checking if the patient has valid coverage. This mistake is very common.
If the patient’s insurance is not active, the company will not pay the bill. Your clinic loses money.
Always check the insurance first. Verify the plan, dates, and limits before giving any medical equipment.
5. Wrong use of modifiers
Modifiers help explain the billing codes. They tell the payer more about the item, like why or how it’s used.
Wrong modifiers can confuse the system. This leads to errors and fast claim rejections from payers.
Use the right modifier every time. Check the latest modifier list before submitting any DME claim.
6. Double claim submission
Sometimes, clinics send the same claim two times by mistake. This is called duplicate submission.
It can lead to system errors or blocked payments. It may even trigger audits or penalties from insurance.
Track all claims carefully. Use billing software that stops duplicate entries before they get sent out.
7. Upcoding or downcoding
Some teams use higher or lower codes than needed. This can bring more money or fewer checks at first.
But payers catch this quickly. It can cause heavy fines or legal trouble for the clinic or provider.
Use the exact code that matches the service. Do not try to bill more or less than the real treatment.
8. No pre-approval
Some DME items need a green light from the insurance before being given to the patient. This is called prior auth.
If you skip this, your claim will get denied fast. This is one of the top billing mistakes today.
Make a checklist of items that need pre-approval. Call the payer first if you are not sure.
9. Mismatched records
The doctor note, the patient record, and the billing code must all match. Even one small mismatch is a problem.
Insurance systems look for perfect match. If the data is off, your claim may get flagged and denied.
Always review records before billing. Make sure every detail is the same on all forms and systems.
10. Old billing rules
DME rules change often. CMS and HIPAA send new updates every year. Ignoring them can cost you big.
Old codes, forms, or rules can make claims fail. You may even break compliance rules by mistake.
Stay updated with new rules. Easy Billing Services always follows the latest changes to help clinics stay safe.
