One of the biggest challenges in DME industry is constant modifications. The cost of employee training, decreased collections, billing mistakes, suspensions due to staff absence are just some of the DME billing issues. Any of these issues could disrupt the provider’s productivity and revenue cycle of the practice.
The intricate and fluctuating nature of DME billing is a matter of concern when it comes to the financial health of the business. Still, with the right processes and measures within the practice, you can rejuvenate your revenue cycle and reduce errors.
Requisites of DME Billing
- Accurate documentation: Ensuring precise documentation is paramount in healthcare billing. Errors can lead to claim denials and penalties. Key documents like physician’s order, evidence of patient need, and delivery documentation all are necessary for efficient billing.
- Eligibility verification: After patient registration, you need to verify the insurance eligibility of the patient. This ensures reduced claim denials and errors within the billing process.
- Right coding: Durable medical equipment is coded under HCPCS level II codes. Precise coding and modifier implementation is necessary. Otherwise, this can result in underpayments or claim denials. Furthermore, over coding within the process can be considered as fraudulent which has an adverse effect on the practice as well.
- Prior-authorization: A paramount aspect of medical billing is prior-authorization. It ensures the applicability of the claims regarding the services and equipment provided.
- 5. Claim submission and follow-up: Timely claim submission is crucial for obtaining reimbursement. Without adherence to the defined deadline, claims get denied.
- 6. Denial management: A system to analyze denial reasons, address them promptly and implement correcting measures can expedite the reimbursements.
Technological Approach in DME Billing
- Billing software: With the technological advancements in healthcare, the digitalization of the billing process is essential. Different software used for medical billing and coding increases efficiency of claim submission and tracking.
- Electronic health records: Integration of EHRs in the billing services of DME can enhance the documentation process while reducing the errors.
- AI and ML: Artificial intelligence and machine learning integration within the process can induce automated billing and coding, predict claim denials and provide insightful measures to reduce the denials.
DME Billing Data Analytics
- Performance metrics analysis: Claim denials rates, accounts receivable days and claim processing time can reveal billing process bottlenecks. It can induce further data-driven decisions.
- Payer behavior analysis: Using data analytics to understand payer payment patterns can provide valuable insights to analyze common reasons for claim denials or delays by specific payers. This can ensure effective claim submission practices for optimized reimbursements.
- Predictive analytics: Advanced data analytics can enable predictive modelling thus helping providers foresee potential issues in the revenue cycle. This will further enable providers to take preemptive actions to mitigate revenue disruptions.
Consider Outsourcing
The current scenario in DME landscape is demanding providers to-
- Process reengineering to optimize results
- Transform the procedures to keep up with the changing market
- Properly train and educate the staff regarding the fluctuations in the guidelines and regulations
- Integrate technology and data analytics to reduce errors
An outsourced organization can be a great answer to all your problems. A genuine partner in DME billing like Sunknowledge Inc can help you with their expertise in medical billing and coding. The team of experienced billers and coders will resurrect your revenue with 100% HIPAA compliance. At just $7 per hour, the team can reduce your overhead expenses by 80%. With great reference and versatility, the team can refine your billing practices in DME services. You can connect with them just over a call to understand what makes them the forerunner in the healthcare billing and coding arena.
