Durable Medical Equipment (DME) billing and coding guidelines are changing over time. Along with that, the patient volume and work pressure are increasing. The demand for DME has increased due to the increasing population and prevalence of chronic disease. Be it increased work volume, excessively long turnaround time in prior authorization and claim settlement, or incorrect entries in bills, there are many evident loopholes. These gaps increase the possibility of fraudulent activities, which can adversely affect your claim settlements and revenue generation.
What is DME Billing Fraud?
The key to successful revenue generation within your business is to effectively execute DME billing. However, some notorious companies bill Medicare beneficiaries for specific equipment without justifying any need and do not even send the billed equipment to the patients.
In most cases, people overlook the small headers and footers where the information related to these products is mentioned. As a result, the DME billing fraud is conducted. Simultaneously, with the consistent skill shortages and skyrocketing wages, it is difficult for the providers to maintain an efficient billing staff.
How to Scrutinize the DME Billing Process?
There are several small things you should be concerned about within the billing process to ensure accurate reimbursements and safeguard your practice from legal and financial
penalties.
While analyzing the chances of fraud within the DME billing process, you should look for the following things:
- If you see an entry for medical equipment that was never ordered
- If there is an entry of a service that was not required
- If a piece of equipment that was taken off your prescription has recurrent payments in cycles of payment
- If you see codes related to services that are more complicated than the performed services
- If you see codes related to services that are less complicated than the performed services
All these are red flags, and if you find any of them within your billing process, then it is time to take a new approach to the organizational procedures. With appropriate staff training, you can resolve these issues. Here is how you should train your staff to ensure efficiency in DME billing:
- Ensure insurance verification
- Ask them to proactively collect co-pays and deductibles
- Use of the latest technology
- Keep them updated about coding and claim submission guidelines
- Align their professional goals with organizational goals
- Provide knowledge about undercoding and upcoding issues
Leverage the Benefit of Partnering with an Expert
With your clinical responsibilities, it is tough to handle an efficient DME billing process within your practice. In this situation, the most pragmatic scenario is to outsource your medical billing services. Sunknowledge Services Inc. is a pioneer in DME billing. The team ensures-
- Timely claim settlement
- 80% reduction in overhead costs
- 100% HIPAA compliance
- 99.9% accuracy on claim submission
- Constant monitoring of the submitted claims
- Consistent communication with all the stakeholders
With a reliable revenue cycle management partner like Sunknowledge, you can eliminate the chances of fraudulence and error within your medical billing and coding practices. Get in touch with them today to understand their services more and why they are hailed as the best in the industry.
