DME billing is complicated, and when healthcare providers use it to boost their revenue, it becomes even more complicated. Today’s DME billing and reimbursement processes are becoming far more intricate, especially with the ever-changing rules and regulations. In fact, the complexity of DME billing currently results in a loss of 3% of overall revenue, with reworking on a denied or rejected claim costing nearly USD 25 per claim.
According to a survey, this results in $262 billion of denied claims each year, causing massive cash-flow issues and recovery costs. However, errors that result in denial claims are a common occurrence in the DME billing process and can be avoided. According to studies, if we can reduce the common billing error, we can recover 80% of denied claims.
Denied and rejected claims in the DME billing process are frequently the result of:
- Clerical error
- Mismatched procedure
- Incomplete information
- Missing deadline in claim submission
- Incorrect ICD codes
So the question is:
How can we resolve denied and rejected DME billing claims?
- Ensuring proper data
As even a minor spelling mistake of a patient’s name or a demographic error can result in DME claim rejection. A person must be very careful when documenting the information.
- Proper verification
According to studies, nearly 75% of DME billing claim denials occur when information is not properly verified. In fact, most of the time, a non-covered or ineligible service is detected during the verification process, resulting in claim rejection. That is why outsourcing organizations are here to not only properly verifying all of the information but also to have a team of expert billers and coders to ensure all information is correctly incorporated before submitting claims.
- Coding method is correct
Proper and correct codes not only aid in the patient’s receiving the appropriate treatment but also aid in the claims process and a faster reimbursement rate.
- Sufficient paperwork
Denials happen when the medical documentation provided is insufficient to support payment for the billed services. If the paper works cannot prove that the:
- Billed services were actually provided
- Provided at the level billed
- Physician signature on an order form
- Each date of service is billed separately
- Service was billed for units allowed within a specific time period for the member
Then such inadequate paperwork is responsible for the Medicare Trust Fund’s waste.
Cutting down on simple DME billing errors in your medical billing process, on the other hand, will not only help you generate more revenue but also get paid faster. There are many outsourcing RCM organizations that can help you focus more on your core work by not only reducing billing errors but also lowering your operational costs by 70%. These RCM organizations have the perfect robust redundancy plan to ensure a seamless DME billing process, with a 99.9% accuracy rate and excellent industry references.
Sunknowledge plays a significant role in resolving DME billing issues
At only $7 per hour, employees who have been trained and are available to work with all major DME billing software are ready to work for you. Sunknowledge Services Inc is a one-stop-shop for HME/DME billing solutions that are stand-alone and end-to-end.
Unlike any other RCM vendor in the healthcare industry, our team can provide assistance remotely during pandemics. Whereas most other RCM vendors are struggling to meet their productivity targets, we continue to set the industry’s highest productivity benchmarks. Because of our dedicated resources, we are able to provide unrivaled and uninterrupted 24×7 supports to all of our HME/DME clients.