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DME Billing: A Comprehensive View During a Global Crisis

So much of how we live and work has changed due to the COVID-19 pandemic, and for pharmacists, durable medical equipment (DME) billing is no exception. In the wake of the pandemic, pharmacists are encountering several new challenges with DME billing, from shrinking profit margins to delayed reimbursements.

This article provides a comprehensive review of DME billing, as well as the steps pharmacies can take to eliminate hurdles and ensure they’re fairly compensated for the equipment and supplies they provide.

What Is DME Billing in Pharmacy?

Along with dispensing medications and providing an array of clinical care services for patients, pharmacists also sell and/or rent out durable medical equipment, which provides therapeutic benefits to patients with specific medical conditions. DME ranges from wheelchairs and oxygen tanks to crutches, canes, walkers, hospital beds, infusion pumps, nebulizers, and more.

While DME can prove quite profitable, billing and getting paid for it is certainly challenging—and definitely an area pharmacists may struggle to accomplish with accuracy and efficiency. According to Rob Boeye, who serves as executive vice president for a home medical equipment software company, pharmacists need to be educated on DME billing practices before rushing into a business model they aren’t prepared for:

For DMEs, billing is more complicated, and naturally a foreign concept for a pharmacy that has no DME experience. Pharmacies should have a clear understanding of the DME industry, particularly around billing and reimbursements. It’s a much more complicated business, and if they don’t like the model, or feel it will be too difficult to keep up with, it’s not going to be a good business to get into.” 

DME billing is different from other types of medical billing because it requires comprehensive, specialized knowledge of HCPCS Level II codes. Plus, DME billing also requires pharmacies to earn durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) accreditation from the National Association of Boards of Pharmacy (NABP) in order to obtain Medicare Part B billing privileges.

Addressing COVID-19’s Impact on DME Billing

If DME billing wasn’t already complex and foreign enough for pharmacists, the global health crisis has introduced challenges with delayed reimbursements and billing inefficiencies. Across the board, care providers (including pharmacists) have experienced delays in reimbursement during the pandemic.

Juggling the demands of treating patients, learning new telehealth workflows and technologies, and adapting to the new normal has delayed several of the internal processes necessary for optimized reimbursements. With limited knowledge of DME billing best practices, pharmacies are also prone to running into barriers that can lead to claim denials, delayed reimbursements, and financial uncertainties. 

Now amid the COVID-19 pandemic, those inefficiencies are more troublesome than before, as pharmacists and pharmacy technicians work tirelessly to offer point-of-care testing, address supply chain shortages, adopt new sanitization and social distancing protocols, and deal with other 2020-related challenges.

Solving the DME Billing Dilemma 

Pharmacists can address these concerns and more by investing in a medical billing solution that streamlines workflows, as well as claims reconciliation software to ensure no money is being left on the table. If you’re struggling to make sense of DME billing, you can utilize medical billing and claims reconciliation solutions specifically designed for pharmacy to:

Increase DME reimbursements

With technology to support your efforts, you can optimize reimbursements for any medical services, equipment, and supplies—including DME. Medical billing solutions for pharmacies help to simplify the claims submission process to improve accuracy and, in turn, increase DME reimbursements.

Automate manual workflows

Using technology to automate DME claims submission will help you say goodbye to manual, time-intensive pharmacy workflows that delay reimbursements and get in the way of patient care. This way, you can expand your medical services without the administrative burden that comes with doing so.

Reduce DME billing workload

Pharmacists and pharmacy technicians are experts at what they do—but they’re certainly not bookkeepers or accountants. With modern technology to guide the DME billing process, you can reduce the heavy lifting for yourself (and your team) and focus more on what you do best: caring for patients.

Eliminate DME billing errors

By putting an end to error-prone manual processes, you can reduce the number of DME claim denials due to data entry and coding mistakes. Gain peace of mind that you’re submitting claims accurately, so you can spend less time crunching numbers and more time interacting with patients at the pharmacy counter.

Reconcile missing payments

It’s not enough to optimize your medical billing workflows. To make sure you’re being paid in full and on time, you also need a solid claims reconciliation strategy. Utilizing a claims reconciliation solution, you can stop using manual processes to chase down unpaid claims and slow-paying third parties.

Using Pharmacy Technology to Improve Your DME Billing

Every moment spent making sense of DME billing, chasing down missing payments, and fighting claim denials is a moment that could be spent delivering better patient care instead. Advanced pharmacy technology such as FDS’s MEDBILL and ECONCILE can provide much-needed support for pharmacies looking to rent and/or sell durable medical equipment. By investing in modern solutions, you can increase your profitability and offer more services, equipment, and supplies for patients in your community.

Looking for more information on the ins and outs of medical and DME billing, their growing importance in pharmacy, and how using the right technology can help transform your business—even amid the COVID-19 pandemic? Watch our free medical billing webinar to learn more.


Amplicare is now part of EnlivenHealth®


FDSRX is now part of EnlivenHealth®