What’s one of the most perplexing problems in DME billing today? Without a doubt, denials and rejection are the most important factors in billing. MGMA says that the cost to redraft denials is $25 for each claim. It can affect Revenue Cycle Management. Denials in medical billing raise administrative scrutiny and are forcing most DME services to update their functioning to achieve maximum productivity and increase profit.
But an important question is why denials and rejection are happening in the DME Billing service. Here are some points to understand why denials are happening in DME medical billing and how to reduce it to make the claim process easy and money-making.
There are 4 things to consider to create DME Denial Management System.
- Verification and eligibility of Patient
- Coding and modifiers
- Documentation
- Process & workflow
Let’s discuss Four points one by one
#1. Verification and eligibility of Patient
The first step is that staff need to verify the details of the patient to ensure that the patient is insured and covered for DME services and about what type of DME service the patient will get insured for. Without rechecking all the information no claims should be processed. Even any mistakes in names or an information box checked wrongly can be the reason for denial of the claim.
#2. Coding and modifiers
DME billing claims can be rejected because of an invalid modifier or if a necessary modifier is missing. It is important to maintain a chart every week so that if any update comes from any regulation that can be instantly informed to the coders and billers. If the DME product is essential then some appropriate codes and modifiers to support “medical necessity”.
#3. Documentation
Right documents are required on file to support medical necessity for the product ordered which is important not only for billers and coders but also if the claim is facing rejection or in the case of auditing, it can explain the details of the claim. For instance, an XK modifier is known to demonstrate that the supplier has written the order and used the supplies/medicine/equipment to cure the patient. The carryon the requested order should be kept on file by the supplier.
This order needs to have the following:
- Indicate the diagnosis/reason for the equipment/medication
- Proper date
- The provider’s signature
Without the following details, the DME billing claim can be rejected/denied.
#4. Process & workflow
Keeping an eye on internal processes and workflows is the most important thing. checking all the considerable points will help you to come out of the problems and loopholes. codes need to be checked and updated against new rules and regulations of insurance policy providers.
Regulations and audits not only take away your revenues but also your productivity. To create a smooth and steady billing process and workflow you need to do some operation changes that are the best way to move forward. If you are providing DME services and you are trying to get fewer denials then your focus should be on the following things:
- Restructuring your organization and processes
- Upgrading the software that will help to streamline processes and also help you to understand your pain points
- Outsourcing your end-to-end DME billing can reduce the denials
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You can increase your revenue growth with Accqdata. Our team will be sharing with you how we manage DME Denials of our client so they can maximise their revenue. To know more about our DME billing services call us: +1-866-631-3108.