ICD-10 and DME Billing- Does Outsourcing Spell More Revenue
                     
ICD-10 and DME Billing- Does Outsourcing Spell More Revenue?
ICD-10 and DME Billing
DME billing is the process of submitting and receiving payment for a claim from the insurance company. 
Implementing, maintaining, and educating staff on proper billing is vital to a DME provider’s success. The 
challenges facing Durable Medical Equipment (DME) organizations with the upcoming ICD-10 coding system 
are plenty. Although the DME you bill for will still employ the same HCPCS codes, the actual difference will be 
in the diagnosis coding itself.
• Firstly, the transition from ICD-9 to the new ICD-10 coding system has led to an increase in the 
number of codes for procedures from 3,824 to 71,924 and simultaneously has also increased the 
number of codes for diagnosis from 14,025 to 69,823.
• Secondly, there are few one-to-one, cross-walked codes in the ICD-10
• Thirdly, it is a known fact that the DME providers receive meager information from the physician to 
convert the codes accurately thus leading to delays in claims causing a shortage in cash flow.
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ICD-10 and DME Billing- Does Outsourcing Spell More Revenue?
• Fourthly, reimbursement of DME incidents needs to establish the necessity of a DME device within a 
treatment episode and the knowledge of the device that covers it. More accurate identification of the 
treatment episode that makes the use of the device eligible for reimbursement is now more than ever 
required
Fifthly, software updates are required, and the capital investment will increase given the training of the staff. 
Moreover, the labor-intensive work like handling dual code sets much after the October 1 2015 deadline until 
all is ironed out, the change in business documents like contracts, bills, training and operation documents, 
etc. associated with ICD-9 codes will all need to be updated.
Is your in-house staff ready to deal with the above 5 challenges? Wouldn’t you prefer them to concentrate on 
their practice priorities? One way to get this done will be by Outsourcing DME billing. But, if you weigh the 
pros and cons of outsourcing, the pros definitely work towards an increase in cash flow, at least in the 
beginning. Keeping tight control over certain aspects of outsourcing will be a win-win. The reasons how 
outsourcing can help improve your revenue
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ICD-10 and DME Billing- Does Outsourcing Spell More Revenue?
• The outsourced billers and coder are well versed with the Medicaid, Medicare, and private health plans
• They are experts in knowing, negotiating, and responding better to the dynamics of DME billing
• Expertise in the transition from ICD-9 to ICD-10 and HCPCS coding will lead to decreased denials. They 
are also well versed with what treatment episodes require what devices and can immediately pull in the 
information
• All the labor, operation and administrative processes, and the capital investment required for the 
transition can be taken care of by the outsourcer while your staff can concentrate on their priorities
For DME providers, to make the ICD-10 transition smooth, outsourcing the administrative and operational 
part can help make this deadline a lot smoother and easier to deal with not just prior to October 1 or later, 
but for many more years down the line.
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ICD-10 and DME Billing- Does Outsourcing Spell More Revenue?
Medical Billers and Coders (MBC) is a leading medical billing company providing complete medical billing 
services. Our certified coders follow accurate DME billing and coding guidelines to ensure an accurate 
selection of procedure codes along with modifiers. To know more about our DME billing and coding services, 
contact us directly at [email protected] or call us at 888-357-3226.
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