When it comes to healthcare consulting, our DME credentialing service is a must-have for anyone looking to avoid revenue loss. Proper credentialing ensures that your DME services are reimbursed by insurance companies, and failure to do so can cost you significant amounts of revenue. Trust our experienced team to get your credentialing done right the first time.
Durable Medical Equipment (DME) encompasses a wide range of essential equipment such as oxygen supplies, wheelchairs, iron lungs, catheters, and more. Launching your own Durable Medical Equipment (DME) company requires careful preparation, including ample time, financial resources, resilience, and unwavering determination. The ultimate goal is to ensure you receive payment for the products your company provides. This involves the process of handling DME bills from clients, which can include patients and healthcare providers. It also entails managing insurance interactions, including billing the insurance, and, ultimately, securing payments for the DME billing. This comprehensive process is commonly referred to as "Credentialing for DME Companies."
Navigating the DME business, often referred to as the Home Medical Equipment business, comes with its share of challenges, and one significant hurdle is 'Provider Credentialing.' Credentialing, in essence, involves verification and goes by various names such as DME credentialing, DME medical credentialing, DME provider enrollment, insurance credentialing, or joining insurance panels. These terms all indicate that patients will make payments through insurance, and your company is officially "In-Network" with insurance providers. Once you successfully become a credentialed provider, the process of receiving payments for DME billing through this network affiliation is known as being an "In-Network" provider. This status translates to more clients and ensures timely and accurate payments. DME companies should consider credentialing with a variety of entities, including government organizations like Medicare, Medicaid, or Tricare, as well as major players in the market such as Aetna, BCBS, UHC, Cigna, among others. Smaller companies are also viable targets, offering the potential for a larger client base with less competition.
DME Credentialing Process:
Secure an office space.
Establish a business bank account.
Formalize your business structure and designate a physical location.
Assemble all necessary documents, including licensing information, background checks, insurance details, and resumes. Ensure that the application is signed, dated, and includes a valid Unique Federal Tax ID#.
The DME provider credentialing process typically spans 90 to 120 business days for 8-12 carriers, encompassing both approval and potential denial stages. Following successful credentialing, you transition to the 'Contracting' phase, which confirms your eligibility to be part of the insurance providers' network. During this phase, the insurance company sends a contract for your review and signature, marking the gateway to network inclusion, typically within the next 30-60 days.
The Centers for Medicare and Medicaid Services (CMS) have approved 10 national accreditation organizations responsible for accrediting suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) to meet new quality standards under Medicare Part B. To enroll or maintain Medicare billing privileges, all DMEPOS suppliers (excluding exempted professionals and others as specified by the Medicare Improvement for Patients and Providers Act of 2008) must adhere to Medicare program supplier standards (as outlined in 42 CFR §424.57 (c)) and attain accreditation (found at www.cms.gov).
It's worth noting that no insurance company recognizes previous claims before network acceptance. Thus, initiating the credentialing process early is advisable to maximize benefits and reimbursements.
Consider our outsourced DME billing and coding services, where we manage the complete spectrum of billing and coding responsibilities on your behalf. This includes preparing claims using appropriate DME codes and modifiers, submitting them, and diligently following up with insurance authorities to ensure timely reimbursement.