DME billing is the process of submitting and receiving payment from an insurance company for a patient’s approved medical equipment. DME billing is a complex and time-consuming process that requires specialized training in addition to traditional medical billing. This article will teach you how to Improve DME Billing Collections so that you can overcome challenges and increase cash flow.
Durable Medical Equipment (DME) billing is one of the most scrutinized billing areas by Medicare and other commercial carriers. One of the main reasons it is frequently investigated is that DME billing Services appear to be anything but simple. Furthermore, when healthcare providers and facilities integrate DME billing into their services to increase revenue, the complexities multiply. Each year, Medicare loses more than $60 billion due to faulty billing, with DME billing accounting for a portion of the waste.
If your practice is losing money due to the DME billing, you are certainly making some errors. You are likely making one of the common errors in the procedure.
Ways to Improve DME Billing Collections
Here are some simple effective ways to improve DME Billing Collections at your practice:
It is necessary to ensure that when the Durable Medical Equipment services are billed, the patient’s insurance coverage has been verified and the services and equipment are covered by the insurance or Medicare. A minor change in the name or the way a form is filled out that is deemed incorrect by the payer will result in claim rejection or denial.
Errors with Codes
If a document indicates a different code than that of the billed or serviced, the insurer will reject reimbursement. In addition, if the service is provided by someone other than the billing provider, the claim will be rejected or denied. Coding errors in medical billing services shown as unbundled will result in the claim being denied. Furthermore, even if the beneficiary has been discharged to another location following the procedure, it is considered an error. Simultaneously, the one in the coded claim is different.
Wrong Use of Modifiers
In DME billing, it is essential that when written codes are used for the service, the appropriate modifiers are mentioned to receive reimbursement for the service rendered. Incorrect modifiers or misaligned code can frequently cause the claim to be rejected or denied.
Payment will be rejected if the medical billing documentation provided lacks adequate or insufficient support for the service provided. Any missing information, such as a physician’s signature on the order, an incomplete form that lacks a date, or if each date of service is not built separately, will result in the claim being denied.
Furthermore, before providing the service, the facility must determine the number of units that service can be delivered to the member within a specific time frame. The claim will be rejected if the number of services provided exceeds the number permitted by the insurance policy.
The necessity of the Medical Assistance
Once medical assistance is provided in DME service, documentation must be provided to demonstrate that the billed service was necessary for the patient. If Medicare coverage and insurance providers believe that medical assistance is not required, the claim will be denied or rejected.
How To Ensure improve DME Billing Collections?
It has been estimated in medical billing services, out of the $3.2 billion that goes to waste in the Medicare Trust Fund, $2.6 billion is due to insufficient documentation. Proper documentation with adequate medical coding and correct information must be provided so that claims are not denied. One of the best ways to avoid this is to outsource DME billing services to a reputable medical billing company like Zee Medical Billing Services.
A specialized medical billing team ensures that all documentation, codes, and modifiers for the claims are correct. They also make sure that claims are submitted on time. Furthermore, any denials are appropriately followed up on. Moreover, because CMS rules and regulations are constantly changing, DME billing staff must be up to date. While it is not always possible, an outsourced partner such as Zee Medical Billing Services will ensure that all DME billing is completed under the new laws and regulations. As a result, there is no claim rejection, allowing you to have a smooth cash flow and revenue management cycle for your DME services.