The new CMS guidelines address the irrelevant equipment utilization and the rising need for proper DME prior authorization.
As of December 21, 2016, prior authorization is mandatory for a list of equipment. The new list may contain some existing equipment and include more too.
Following such regulatory guidelines can be beneficial for healthcare providers as it will help them achieve efficient DME revenue cycle management.
However, to reach a place of financial stability, DME providers must understand the terms of DME prior authorization and follow all guidelines and standards.
This will improve the bottom line and the productivity of operational management. If you are a DME provider facing issues in following up with prior authorization requirements, then this blog is for you.
In this blog, we will understand the basics of DME prior authorization and learn ways to boost the process.
Defining DME Prior Authorization
Whenever there is costly equipment involved in patient treatment, insurance companies need confirmation if equipment is medically necessary or not. As a result, healthcare providers must get prior approval from insurance companies to acquire adequate reimbursement.
Only after the authorization process, healthcare providers can carry on with their treatment. This process is crucial to prevent errors in medical billing and avoid unnecessary claim denials.
However, the time-consuming and tedious nature of this process makes it challenging for healthcare providers. To counter such intricacy, DME providers search for professional prior authorization services. This way DMEPOS companies can attain enough revenue and enhance their bottom line.
Ways to Improve Your DME Prior Authorization
It is common for DME providers to face issues in the prior authorization process. However, the absence of taking any reliable actions is not the solution. With a few tips, healthcare providers can streamline DME prior authorization and lead their practice to profitability.
Healthcare providers must keep certain things in mind, and they are: being up to date with constantly evolving billing guidelines and optimizing your prior authorization process to follow the new guidelines.
Healthcare providers can closely follow the list authorized by CMS and make sure they attain prior authorization based on that list.
Apart from that, consider the following points:
Verification of Insurance Eligibility
If you think that eligibility verification is only about collecting patient data and recording insurance details, then you are wrong. Checking for eligibility is more about tracking the essential points of insurance and uncovering its details.
This way healthcare providers can find out the terms for specific equipment, major deductibles, and the need for referrals for different treatment plans. Another important factor is the time of eligibility verification, the first is during patient entry and the second is if any claims get denied. This step is essential to improve the DME prior authorization process and make it efficient.
Confirmation of Payer Guidelines
Other than insurance verification, healthcare providers must also check payer guidelines. In case the insurance company doesn’t compensate for equipment, healthcare providers must be able to lay that responsibility on payers.
However, this is possible only when the payer guidelines make a patient eligible to make the payment. Confirming payer guidelines is also helpful if healthcare providers are dealing with out-of-network insurance companies.
The healthcare providers have to make an informed choice regarding this. They can either receive revenue from insurance companies or a patient.
Maintaining a Patient Checklist
Maintaining a patient checklist can really help track the patients who need DME prior authorization. The list will include the patients who need prior authorization and the status of approvals.
This also helps in determining accurate CPT codes and modifiers for DME. Keeping a record can be effective for DME medical billing in many ways and uplift the overall DME revenue cycle management.
Establishing Patient Responsibility
Establishing patient responsibility at the beginning gives healthcare providers a kickstart to their medical billing process. This involves insurance eligibility, identifying coverage policies, finding deductibles, and understanding specific coverage rules.
This is a time-consuming process, but it helps in making patients aware of their treatment plans and procedures. In the case of DME, patients will be aware of their equipment, its authorization, and other details.
This step helps healthcare providers in gaining clarity and in improving DME revenue cycle management.
Pre-Patient Visit Essentials
There are certain factors healthcare providers must consider before patients visit the facility. They need to record and document vital patient data, their insurance coverage, and their intended DME plan.
Keeping records and documenting them accurately is essential to ensuring the exactness of claims. This further helps in getting claims paid, maximizing revenue, and upgrading the operations.
Taking care of DME prior authorization can lead to better results in all aspects of medical billing and help DMEPOS companies reach a satisfactory bottom line.
Proper Documentation
Remember documentation can make or break the medical billing process. This is the same for DME prior authorization. The biggest challenge in documentation is manual errors that result in denials and revenue loss.
Healthcare providers can prevent it by opting for prior authorization services from expert medical billing companies. As a result, healthcare providers can eliminate errors caused by negligence and enhance their operational efficiency.
Outsourcing DME Prior Authorization Services
DME prior authorization process plays a crucial role in ensuring that healthcare providers are paid on time and adequately. Though reaching perfection is a challenge, once healthcare providers attain efficiency, they can acquire adequate revenue effortlessly.
Outsourcing partner helps healthcare providers in dealing with complexities and achieve seamless workflow. They take a healthcare practice to better revenue cycle management and proper operational management. With professional services, healthcare providers can shift the medical billing burden and focus on delivering quality patient care.
Why Choose Eminence RCM
If you are seeking effective DME prior authorization services, then Eminence RCM is the right choice for you.
Eminence RCM is a leading medical billing company providing a range of services to various healthcare providers across the USA. We work with a certified team of coders and billers proficient in handling DME prior authorization.
We know that a streamlined revenue cycle management is a must to keep the healthcare practice going. Our services are designed to meet all the requirements of healthcare providers. We take complete measures to eliminate challenges and elevate the performance of healthcare practice.
Moreover, we always stay HIPAA compliant to prevent sensitive patient information from misuse. Our medical billing services are targeted towards maximizing your revenue and simplifying operational management.
With our services, you can achieve adequate reimbursement while focusing on delivering quality patient care.
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