Family Doctor Billing DME

Have you had a problem getting durable medical equipment (DME) billed through your family doctor? You are not alone. There are several factors that make family doctor billing DME complicated.

The first issue is that often the family doctor is not allowed to diagnose a condition for which DME is indicated. An example of this is sleep apnea treated by a continuous positive air pressure (CPAP) device. Most general practitioners do not have the training necessary to distinguish between the various sleep disorders, so the patient must be referred to a specialist in sleep medicine. The specialist has the training, equipment, facilities, and personnel needed to do the sleep testing necessary for the accurate diagnosis and successful treatment of sleep disorders. As such, any billing related to the process has to be done through the specialist’s office.

This issue occurs whenever your family doctor is required to refer a patient to an outside entity, be it a specialist, a hospital, or a rehabilitation center. For instance, a patient given crutches to allow him to negotiate with a broken leg has to pay for them through the hospital where he was treated, instead of his attending physician. This can apply to surgical hardware (hardware installed inside the body) as well, although it does not occur as often because such work is usually done by a specialist (e.g. an orthopedic surgeon).

One would think that it would be simpler for everyone involved to be able to centralize billing through one entity, in this case one’s family doctor. In particular, it would be a huge time and cost saving for insurers, be they insurance companies or business concerns who self-insure their employees. The problem is that when medical businesses cooperate, of necessity they have different yet entangled economical interests. The individual or company that can untie this Gordian knot will no doubt create useful medical billing guides.

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