For providers, knowing the estimated reimbursement of services before they are rendered is a critical component of the healthcare revenue cycle. The first step in calculating reimbursement is verifying what codes can be billed for the provided services. When manufacturers go through the process of DME Coding System code verification to obtain a PDAC letter, code selection for supplies and equipment becomes trivial. However, for most billable codes, code verification is voluntary. What do providers do when they want to provide a DMEPOS item that hasn’t gone through the verification process?
A common practice among providers is to turn to manufacturer-suggested HCPCS codes to help in coding selection. While many manufacturers work closely with practitioners and insurance companies to understand best coding and billing practices, not going through the PDAC process means there is no guarantee the suggested codes will be approved for reimbursement. Case in point, many manufacturers will issue a disclaimer on suggested codes waiving their own liability for them.