A critical look at HME billing

In the realm of HME billing, one of the most common issues faced by providers is getting their claims turned down by insurance payers. In spite of their best intentions, denials and rejections are alarmingly frequent in HME billing. The chief reason for this lies in a lack of knowledge of reimbursement caveats and the various norms and regulations that need to be adhered to when seeking compensation from a specific insurance payer. This, coupled with a general absence of accuracy and a thorough approach to the process, contributes to frequent denials and consequently, loss of revenue.

Maintaining an appreciable degree of productivity in HME billing has always been a major worry for HME providers and suppliers. Dips in the graph are common. However, they can get alarming if they are too often and too many. One of the biggest hurdles in HME billing is obtaining Prior Authorization for a prescribed device or supply. Next comes coding which is a challenging affair given the details that a coder needs to get to in order to create that ‘perfect’ claim.

All these can be managed and handled by a competent team of billing personnel. However, expert billers and coders don’t come easy, and they sure don’t come cheap. In the midst of a critical scarcity of skilled labor that is plaguing the job market currently, things have seldom been more difficult. So, is there a way to economically and effectively build a more productive billing department for an HME practice?

Aiming for better productivity

The answer lies in strategic outsourcing of the billing process, either in part or in whole, to professional offshore agencies known to provide professional assistance in billing, coding and other aspects of Revenue Cycle Management. The mention of outsourcing business processes often raises quite a few eyebrows. The opinions are mostly varied. There is a camp that fails to see any real merit in outsourcing. There is yet another coterie that is undecided. However, a large section sounds fully assured of the many benefits of having an external billing partner. The crux of the matter lies in choosing wisely, as billing service providers come in all shapes and sizes, and one must pick the best one to work with to ensure the most favorable results.

The main benefit of outsourcing a billing process to a billing agency is the degree of dedicated attention that the process receives from such an association. With such attention, errors are reduced, denials get slashed and more claims get passed than before. In short, there is a definite boost in productivity and providers can finally breathe easy knowing that their billing operations are in capable hands, without having to spend a fortune for such stellar support.

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