DME or Durable Medical Equipment refers to those types of equipment which are necessary for the quality treatment of patients. A survey reveals that approximately 39.9% of DME billings are improper. This leads to an annual loss of more than $3.2 billion from the Medicare Fund.
It is essential for the best DME billing companies USA for ensuring timely settlements. Minimizing delays as well as complete settlements help in the smooth functioning of the institute.
Problems In DME Billing
Medical billing always comes with multiple problems. DME billing process is even more complicated. This is because of the multiple billing cases which are not inside the institute. Therefore, it becomes very difficult for the billing company to validate each claim before settling. This in turn leads to delays. A few other problems in DME billing are –
Insufficient Documentation –
This happens when the necessary documents for claim settlements are not submitted along with the claims. This leads to a long delay in the settlement process. Some common examples of insufficient documentation are –
- The number of billed units is more than the permissible limit for any patient.
- The different service dates are not separately billed.
- The signature of the physician or the prescription by a regular doctor is missing.
- The documentation still does not give enough proof to ensure that the services were at the billing level only.
Medical Necessity –
This happens when the documentation does not provide enough reasons for the use of a particular type of equipment. This may be due to any reason. When the payment policies detect the billing of any equipment that is not mentioned in the coverage policy, then the claims are on hold till rectification.
Coding Errors –
Errors primarily happen due to 2 reasons. Manual coding is the biggest reason for errors. Non-updation in regulations as per the latest updates is the second major reason. Some of the most common coding errors include –
- Unbundling of the service. – It is essential to keep the bills grouped as per the existing requirement. In case of unbundling the group, and attempting to increase the charges, the bill is kept on hold.
- The patient got discharged from a place other than the one which is mentioned on the bill.
- The code indicates that the service provider was different from the billing provider.
- The supporting documents indicate a code different from the billed code.
Verification of Patient Data –
Simple errors in the form of patient names, age, and other details lead to one of the most intriguing delays. These issues require immediate rectification. Following automation and proper protocols help in overcoming all these issues.
Overcoming These Solutions
There are regular challenges that keep coming up in the coding process. It is essential to overcome these issues for the smooth functioning of the institute. A few tips for improving the coding process are –
Accurate Verification –
It is essential for the accurate verification of the details. This gives a clear picture of whether the patient is covered or not. They also should ensure that the processing of claims starts only after verification of the details.
Confident Documentation –
There are multiple requirements in the documentation process. This includes –
- Making sure that the usage of the right modifiers in order to ensure timely reimbursement.
- Having a thorough knowledge of the major insurance providers so as to enable quick reconciliations.
- Proper understanding of the delivery rules for conforming to successful delivery.
Avoiding Errors in Documentation –
- As a strict condition, make sure that the hospital staff ensures complete and accurate collection of patient data. Collecting at least the past 6 months’ data of the patient so as to have a complete understanding.
- Ensure that the practitioner has a valid National Provider Identifier.
- Through analyzing and understanding of the Healthcare Common Procedure Coding System (HCPCS) code.
Affirming Medical necessity –
Trying to prove the medical necessity of any patient takes a very long time. Therefore it is essential for the proper prescription as well as clinical documentation to ensure ;
- Medical record of the patient
- Benefits and outcomes after the use of prescribed DME.
- Plan of treatment by a qualified practitioner.
It is essential for billing companies to ensure a smooth revenue flow. Having a steady flow of revenue helps in improving the quality of care for patients.
The best DME billing companies USA provide DME billing as part of their RCM package. These companies take up regular efforts to improve billing conditions. Minor adjustments in the regular work cycle will help in the tremendous improvement of the process.