Concerning Error Rates Released on DME Billing

Marissa Clemmer, CPC, CCS, CPMA, CPB, CANPC, CPEDC
Karen Zupko and Associates, Inc.

In the October 2023 AAOS Now article, “Concerning Error Rates Released on DME Billing,” Marissa Clemmer, CPC, CCS, CPMA, CPB, CANPC, CPEDC, highlights concerning Medicare error-rate data related to durable medical equipment (DME) billing in orthopaedic practices. Reported error rates were notably high for commonly dispensed items, including ankle-foot orthoses, knee orthoses, and spinal orthoses, underscoring significant compliance and revenue risks.

The article outlines common reasons for DME claim denials, such as incorrect HCPCS codes, missing or incomplete documentation, lack of medical necessity support, and failure to meet local coverage determination (LCD) requirements. It emphasizes that these errors can result in delayed or lost reimbursement for already-dispensed equipment, creating substantial financial impact for practices.

To reduce risk, the article recommends steps orthopaedic practices can take to improve DME billing compliance, including understanding DME MAC requirements, maintaining thorough documentation, staying current on payer guidelines, responding promptly to audit requests, and training staff on proper use of written orders and proof of delivery. This article serves as an important reminder of the need for strong DME processes to protect both compliance and revenue.

Read the full article on AAOS Now: