“Improving DME medical billing and maximizing revenue are integral achievements for DME providers.”
Your job as a durable medical equipment (DME) provider doesn’t end with prescribing equipment to patients. Rather it concludes with successful completion of DME medical billing and achieving profit.
Meeting two important goals such as handling patients and ensuring accurate medical billing is a complex task. However, running a successful DME practice is all about striking an effective balance.
This blog is your guide to solving your daily DME billing requirements and enhancing overall financial posture. So, read on to know more about how you can turn the tables and achieve financial growth.
Top DME Billing Complexities Affecting Your Practice
To understand the root cause of intricacies, we will look at different medical billing steps. And learn how issues within that step affect the overall billing process.
1. Insurance Verification and Prior Authorization
Both these steps are fundamental to ensuring billing accuracy and efficiency.
Insurance verification checks the policy coverage available to a patient and allows providers so that they can continue their treatment. In the case of DME, it is crucial that your patient’s insurance coverage includes medical necessity, type of equipment and whether item is meant for home use.
On the other hand, for prior authorization, the DME provider must get approval from the insurance company. If you fail to check patient’s coverage, then later it might lead to claim denials and revenue leakages.
2. DME Documentation and Data Recording
The next important step is documentation and data recording. After you have allotted durable medical equipment to the patient, it’s time to record it. Documentation includes a patient’s medical history (prescription, written order, proof of delivery and more) and personal details (date of birth, phone number, address, insurance policy number and more).
Manual errors or missing details during documentation process are the key reasons behind inaccuracies during coding. These faults have a direct effect on CPT, ICD and HCPCS codes causing financial damage.
Whether it is lack of medical necessity, missing pre-authorization or inconsistent data, the challenge will always remain until you simplify your documentation process.
3. Coding Issues in DME Medical Billing
After documentation, the next step in DME medical billing is coding. This step is considered as most important because it is prone to frequent errors. Inaccuracies happen due to various reasons including lack of coding expertise, manual mistakes, changing guidelines and more.
However, coding mistakes are more than just writing wrong codes, and they include over-coding, under-coding, unbundling of codes, duplicate coding, wrong modifiers and former codes.
Whether you are dealing with ICD-10 or CPT codes, there are constant changes in the coding regulations. If you don’t keep up with them then coding errors are bound to happen in your DME medical billing.
As a DME provider, you must integrate certain steps in your medical billing process, and they are: performing regular audits to check accuracy, streamlining the process with coding changes, creating a checklist to ensure all claim filing requirements are met and optimizing different coding needs according to payer policies.
4. DME Medical Billing Standards and Legal Regulations
DME providers must be aware of the fact that when it comes to medical billing, they have certain legal responsibilities as well. These include following compliance standard and protecting sensitive patient information from misuse.
When healthcare providers document patient history and personal details, it becomes crucial to safeguard that data. For this DME providers have to comply with a well-known compliance standard called HIPAA.
This standard secures the interest of the patients and makes it mandatory for healthcare providers to comply. If they fail to follow HIPAA compliance, then they are subject to legal consequences such as penalties.
5. Claims Denial Resolution Process
If DME medical billing steps are not handled properly, they lead to claim denials and disrupt the revenue flow. If your practice doesn’t have a framework for denial resolution, then your practice will result in reimbursement leakages.
Denial resolution or denial management process is essential to recover financial loss caused by denied claims. It also improves the medical billing process to limit denials in the first place.
This process plays a central role in maximizing efficiency of your DME billing and achieving revenue goals. If you don’t already have a dedicated denial management then you are behind the current approach.
What is the Solution?
Medical billing services in Delaware!
All the complexities mentioned above need a straightforward approach. The role of medical billing services is to help you change the approach from merely avoiding challenges to reaching targets.
You can also invest in hiring an in-house billing staff but the cost and hassle of maintaining it can be a lot. On the other hand, medical billing services set you free from the stress, inconvenience and expenses of in-house staff.
Medical billers are your one stop solution as they offer expertise, on-time medical billing, coding accuracy and claim submission efficiency. On top of that, they follow a denial management process and HIPAA compliance.
The benefits that medical billing services can offer also include applying smart tools to improve accuracy and eliminate manual errors, monitor vital metrics and make your DME revenue cycle better.
Choose Eminence RCM
If you want medical billing services in Delaware, then Eminence RCM offers DME billing. We have been working with DME providers and helping them achieve a stable cash flow.
We strive to connect your business goals with exceptional patient experiences. Our team of medical billers and coders is qualified and has the expertise to handle your billing process. We start by identifying the root cause of complexities in your administrative process and solving every roadblock.
From patient registration to payment posting, our team ensures comprehensive accuracy and efficiency throughout. We also ensure proper denial management and follow-up on claims to optimize the process.
Partner with Eminence RCM and experience DME billing expertise. Take your practice higher with precise handling of complex medical billing steps. Adequate reimbursement is right ahead! Contact us!
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