Do you want to maximize reimbursement and stay on top of payer guidelines? The place to start is to analyze and streamline the DME billing process. Most DME providers are stuck with slow billing cycles and fragmented processes.
According to a study by CERT, the DME billing space has a 39.9% improper payment rate. The error rate for DME billing is three times higher than the national average of 12.1%.
How do you avoid the baggage of this industry and gain maximum reimbursement?
The old way of medical billing is being hamstrung by incorrect documentation and manual processes. The smarter way to handle billing is to utilize automation and automate time-consuming, repetitive processes. Because the DME billing process involves multiple tiers of approvals and follow-ups. And it can lead to missing TFL (Timely filing limits) and letting revenue slip through the cracks.
In a survey by The Department of Health and Human Services stated that documentation errors were the leading cause of claim denials in the DME space. To optimize reimbursement it is important to focus on complete and accurate documentation. Clear documentation at every stage of the revenue cycle improves reimbursement and minimizes denials. It helps DME providers to break the cycle of inefficiency and ensure a higher first pass claim acceptance rate.
Modifiers are mandatory for DME billing and assigning the right modifier is crucial to avoid claim denials. Unlike medical billing for other specialties where modifiers are optional and do not have an impact on denials. Also, DME billing requires in-depth knowledge of HCPCS level 2 codes. Generally, HCPCS level 1 codes are used for medical billing.
The DME billing cycle hinges on documentation and approvals at multiple levels. A novice billing team can drown under the sheer amount of paperwork required to get DME claims out the door.
Infusing intelligence in the medical coding process is crucial to improve collections. Insurers determine reimbursement for DMEs based on clinical validation. It is increasingly important to focus on medical coding and clinical documentation improvement initiatives.
There are specific codes for renting versus buying durable medical equipment. Coding for DME is in general focused on specific DME items and not medical procedures. This can be challenging for coders who are not well-versed with assigning codes for DME.
A coding cycle that is driven by artificial intelligence and smart work queues can power the billing process and instill more efficiency in the coding cycle.
To ensure reimbursement, record and document face-to-face encounter and evaluation of the patient prior to placing an order for DME equipment. It is essential that the doctor and DME supplier are enrolled with Medicare. The doctor’s NPI should be clearly mentioned in the order for DME supplies. Medical necessity should be clearly ascertained.
To establish medical necessity understand Medicare’s coverage policies.
The patient’s medical condition, the functional status of the patient and detailed information on how the DME will support the patient and enable healthy patient outcomes, is mandatory to support medical necessity and ensure reimbursement.
To maximize reimbursement and ensure compliance with Medicare guidelines partner with a DME billing specialist. It can make or break your billing cycle.