Are you looking for insurance credentialing and medical billing for Durable Medical Equipment (DME) companies?
It takes substantial resources and time to start a DME company, so the last obstacle you want to face is accepting payments from customers. Many clients today rely on their medical insurance for the price, which means medical credentialing and billing are essential for a DME company's success.
This means the task for you is to be able to accept their insurance, bill the insurance company and receive payment from them. You can’t do any of this unless you have been credentialed with the best insurance companies and start submitting claims.
What is Durable Medical Equipment (DME)?
Durable Medical Equipment (DME) is medical equipment ordered by healthcare providers, primarily physicians. Such medical equipment provides therapeutic benefits to patients in need with acute or chronic medical illnesses. Common examples include wheelchairs, hospital beds, CPAP /BiPAP machines, Peritoneal Dialysis machines, walkers, oxygen equipment, canes, crutches, monitors, etc.
What is Medical Credentialing?
Medical credentialing means that you have become in-network with an insurance company and are now able to receive payments as an in-network provider. This allows you to expand your customer base and be reimbursed on time.
How do you choose which insurance company to become in-network with?
The answer to that question is not so simple. You have a list of more prominent companies to browse, such as Blue Cross Blue Shield, Cigna, Aetna, and others. But you also have to pick from an extensive list of government organizations, such as Medicare, Medicaid, and Tricare. As you can see, finding the insurance company that is a good match for your DME company can and will take time. We recommend getting into the network with Medicare, all managed medicare / MCOs, as many patients who need DME are medicare age population.
What about smaller insurance companies? Typically, companies aren’t quick to consider the smaller providers, but the chances are that they may be the most profitable investment for you. Being a large fish in a small pond means that you have access to clients no one else has. Although being in-network with BCBS is ideal, plenty of smaller competitors is to consider.
Steps to becoming a DME supplier
Register your company with the state. Takes 1-2 weeks. Get a Unique Federal Tax ID / EIN. Usually a quick process. Obtain NPI (National Provider Identification) via NPPESPromise to Meet all DME Standards. To become an accredited DME supplier, CMS requires you to meet a set of 42 Code of Federal Regulations (CFR) supplier standards. Go Through the DME Accreditation Process With an Approved Accreditation Company. The Centers for Medicare and Medicaid Services (CMS) has approved 10 National accreditation organizations that will accredit suppliers of durable medical equipment companies, orthopedic, prosthetic, and supplies (DMEPOS) as meeting quality standards under Medicare Part B. This accreditation may take 3-9 months. Obtain a security bond of $50k (Usually cost around $300-$1000). This Bond is required per CMS. Prepare all documents such as license, accreditation, insurance, resume, and background. Before applying to the payer, check that the application has been signed, dated, and completed thoroughly.
How do I even start the credentialing?
This process is time-consuming and arduous for any company, especially DME providers. It would help if you started everything as early as possible by planning what information will be needed for your first application. This report will include a detailed summary of your services over time and many relevant documents.
Ideally, you want to start in-network with 8-12 carriers, which can take about 3-4 months or more.
The trick is that each insurance company has its methods to verify your DME company, and your application rests in the hands of a committee that has to approve you. If you are approved, then the process of contracting begins. After signing and submission, it will take 1 or 2 months for the process to be completed.
Remember that when you have become in-network, the insurance company will not accept claims preceding submission. Hence the process needs to be started early.
Consider hiring Credentialing.com for getting your practice credentialed. We know all of the steps to getting your DME company matched with the perfect insurance company for your practice, and you don’t have to spend the time you don’t have on a process you’re uncertain about. We’ll get the job done.