If DME prior authorization is not acquired before the service is done, the claim may be denied. High-cost supplemental treatments, surgical procedures, or services that may be deemed unnecessary in some circumstances usually necessitate prior authorization.
Unfortunately, the requirement for DME prior authorization frequently causes crucial health care delays. This can effect on both patient satisfaction and patient outcomes. An AMA poll found that physicians and staff spend an average of 2 – 3 business days each week complying with previous authorizations.
Although the American Medical Association (AMA) continues to advocate for payers to adjust their DME prior permission rules, it is now vital for your practice to learn how to manage authorization appropriately for the sake of your patients and income.
Even though your clinic works hard to efficiently manage DME prior authorization. Claims are occasionally denied for a variety of reasons. The following are some of the most common causes for DME prior authorization denials. As well as steps you may take to avoid them and keep the money flowing in your practice:
Unable to Provide a Claims Form Number
An automated system is frequently used to process claims. The absence of a DME prior authorization number on the claim may cause the system to reject the claim. If the payer does not conduct a manual check, they may miss the fact that you have gotten DME prior authorization.
These denials are frequently avoidable. Simply double-check that you’ve correctly written the previous authorization number on the claim. It’s a straightforward repair that will save you both time and resources in your practice.
A fraction of the claim has been approved
Given the fact that just one service on the claim had prior authorization, the claim may be denied. This is, once again, a relatively easy thing to avoid. Employees in billing and coding must pay special attention to all services listed on a claim.
Billing and coding professionals must work with providers to get a thorough understanding of which services require DME prior authorization and make sure that all approvals are in place before services are given.
Inability to Obtain Authorization before Treatment
It is not always possible to obtain previous authorization before receiving treatment, particularly if the client is classified as an emergency and you do not have time to do so. When dealing with such an urgent issue, you’ll frequently discover that payers are willing to be flexible. They aren’t usually very accommodating when it comes to non-emergency care.
Incorrectly submitted by the insurer
A claim may be denied simply because the payer did not handle it properly. If you receive an unexplained denial, you must have personnel who can contact the payer to find out why the claim was denied and whether that answer is legitimate. When this occurs, discuss the matter with the payer’s representative over the phone to identify the problem and prevent further delays.
Hence to summarize, DME Prior authorization can be a big nuisance for your clinic to deal with, and it’s a major cause of claim denials. Don’t be afraid to file an appeal if a payer denies your claim. While calling payers to discuss denials is time-consuming, it is very effective in affecting the outcome of your case. Another thing to think about is outsourcing your billing and coding. Expert billing and coding businesses specialize in managing claim denials and preventing future denials. This will result in more money for your clinic.