Durable Medical Equipment (DME) suppliers provide devices that help patients live independently and perform daily tasks. Because of this, DME is in high demand, and suppliers work hard to deliver equipment on time. While supplying devices is their main job, billing adds a big challenge. Your staff becomes always overwhelmed with the piles of paperwork as we all know that managing the DME RCM is complex and time-consuming.
Your DME billing always becomes complex and vulnerable with all the insurance denials and regulatory compliance. Complex medical coding and documentation formalities add to the challenges and you can face denied claims because of a small error in your billing process.
Without efficient appeals, denied claims pile up and become hard to manage. This is where DME billing outsourcing helps. The experts in a professional DME billing company always boast adequate knowledge of the process, keeping claims accurate and helping you get prompt reimbursements. Now, it’s crucial to understand the reasons why DME billing is so complex before knowing about the major benefits of outsourcing.
Know about the regular challenges of the DME billing process:
DME includes many medical devices, from crutches to advanced hospital beds. Billing for these items is detailed and requires a clear understanding of the whole process. This complexity often makes DME billing frustrating for suppliers.
Frequent regulatory updates:
All the insurance payers keep updating their rules for DME billing and you can only avoid mistakes and penalties if your staff members stay on top of all the rules. Here is an example- An insurance payer has already updated its rules for documenting a wheelchair, and you can face claim denials and payment loss if your staff members don’t adjust the documentation process accordingly. You cannot afford to miss a single detail when it comes to staying compliant all the time.
Constant changes in payer policies:
You cannot expect to deal with same rules all the time as federal and commercial payers update their policies frequently. You should always provide regular training sessions to your staff members so that they can always stay updated and avoid facing billing errors and claims denials.
Medical necessity always plays a vital role in your DME billing process as practices failing to prove it, always face claim denials and payment loss. Your billing staff member should always ensure that every note is showing the exact patient need for the specific durable medical equipment. You will face claim denials because of missing documents that justify the medical necessity.
Most medical equipment needs prior authorization (PA) from payers before it can be delivered. Getting PA is not easy and requires correct coding and complete documentation. Let’s go through an example here- one of your patients needs a motorized wheelchair and your administrative team needs to show how the wheelchair improves their mobility and daily functions. Always remember that insurance payers only approve your PA request when they are provided with the proper proof of medical necessity. Your prior authorization request can always be rejected because of missing details.
Denials from insurance companies are very common in DME billing practices and suppliers always lose a lot of money because of these denials. It is always important for you to implement the perfect denial management strategies to ensure that claims are corrected, resubmitted and reimbursed properly.
No wonder these DME billing challenges always lead your practice to face staff burnout and frustrated patients waiting for the devices. So, what’s the solution? You can simply go for outsourcing DME billing.
A professional DME billing company knows what it takes to manage your end-to-end revenue cycle management process so that you can enjoy the best revenue outcomes with optimal patient satisfaction. A reputed DME billing company always enables you to save almost 80% on your operational costs, while showing you a significant revenue growth. Hire a perfect DME billing partner today and see your practice thriving.
