HME and DME billing are the two types of billing done in the medical industry. Both these billings are done for medical equipment that is being used by patients. However, both types of medical billing are quite different in various aspects which can be quite confusing for some. So in this post, we will discuss the difference between HME and DME billing services. But before we begin, it’s important to clear the confusion that what HME and DME billing is. So let’s start with that.
What is HME in Medical Billing?
HME which is the abbreviation for Home Medical Equipment refers to any type of medical equipment and supplies that are being used in a patient’s home to support his/her healthcare activities. This type of equipment and supplies is generally used to help patients with mobility issues, chronic conditions, or disabilities. Some examples of HME include wheelchairs, oxygen tanks, and hospital beds.
HME billing services refer to the process of billing insurance companies or other payers for the cost of HME equipment. This process involves accurately coding and billing for the equipment, as well as coordinating with the patient and healthcare provider to ensure that the equipment is being used correctly and effectively.
What is DME in Medical Billing?
DME is the abbreviation for Durable Medical Equipment is referred to any medical equipment or supplies that are being used in a healthcare facility and are designed for repeated use. Equipment or supplies covered by DME are generally used in hospitals, clinics, and other healthcare facilities to help patients with day-to-day healthcare activities. Equipment and supplies that are covered by DME include crutches, walkers, and medical devices used in rehabilitation.
DME billing service is for the billing that is done to receive the reimbursement for DME equipment and supplies used by the patient from insurance companies or other payers. Very much similar to HME, the DME billing process involves coding and billing for the equipment.
4 Differences between HME and DME Billing Services:
1- Equipment:
One of the main differences between HME and DME billing services is the types of equipment that are being used. While HME equipment is used in a patient’s home, DME equipment is used in a healthcare facility. This means that HME billing services are typically focused on billing for equipment that is used in the home, while DME billing services are focused on billing for equipment that is used in a hospital or clinic.
2- Insurance Coverage:
The second big difference between HME and DME billing services is that they offer different types of insurance coverage.
HME equipment is generally covered by Medicare and private insurance. Though DME equipment is also covered by Medicare and private insurance, it is also covered by Medicaid.
This means that in DME billing, you will have to deal with more payers, while in HME billing, you will have to deal with a lesser number of payers.
3- Billing Process:
Another key difference between HME and DME billing services is the process for billing. In HME billing, equipment and services used by a patient are generally billed every month. This is because the equipment and supplies that are provided are being used regularly and need to be replaced or refilled regularly.
However, in DME billing, equipment, and services are billed one time only. The reason behind this is that the equipment provided is not of disposable nature and is expected to last for a longer period.
4- Documentation Requirements:
Even when it comes to documentation requirements, HME and DME billing services are quite different. HME billing service requires more comprehensive documentation, including a detailed explanation of the patient’s medical condition, the specific equipment and supplies that are being used, and the reason for their use.
On the other hand, the medical billing service requires less detailed documentation. Only specific details about equipment and supplies that are being used are documented in DME billing.
What Are Some Common Issues That Can Arise In HME And DME Billing?
Claim Denials:
One of the most common issues that occur in HME and DME billing is claim denial. It has been seen often that insurance providers denied a claim for different reasons, such as lack of medical necessity or incorrect documentation.
Claim Underpayments:
It’s quite common in DME and HME billing that the Insurance providers pay less than the full amount of the claim, requiring the healthcare provider to submit an appeal to reimburse the remaining payment.
Billing Errors:
Likewise, in medical billing, errors are very much possible in billing too. Any mistake in the billing process, such as incorrect coding or missing information, can result in claim denials or underpayments.
Payment Delays:
The process of both HME and DME billing is very complex and time-consuming, and sometimes that results in payments being delayed which causes an issue for both healthcare providers and patients.
Insurance Coverage Issues:
Another common issue that arises in billing is the insurance coverage conflict. Often it happens that a patient has no or limited insurance coverage for certain medical equipment or supplies that he/she is using which leads to out-of-pocket expenses and causes conflict.
Conclusion:
In the end, we hope that you are longer confused between HME and DME billing services. Understanding the differences between these two types of medical billing services is not just important for healthcare providers and patients but also for other stakeholders involved in the billing process. By working together, all the stakeholders involved in billing can ensure that patients have access to the medical equipment they need while ensuring that the billing process is handled accurately and efficiently.
