Sunknowledge: Offers A Detailed DME Billing With Robust Redundancy Plan

When a DME product is acquired by the patient a bill is formulated known as DME billing. The DME billing is where every needed detail along with compile documents catalog and records for claims submission are done to ensure proper reimbursement later. This brings us to, what is DME.

DME (Durable Medical Equipment) is a therapeutic or medical piece of equipment that licensed physicians prescribes to the needed patients due to specific illness or medical conditions for a better state of life. Making life accessible or simple for a person, the DME products include are wheelchair, nebulizers, CPAP, kidney machines, and many more.

Market analysis of the (DME) Durable Medical Equipment:

Propelling the overall demand for durable medical equipment (DME) in the country, a survey forecast of 2019-2026 for the area of MEA, APAC region and also for Europe, North America stated that the market size to further rise up to USD 271 billion by the end-user (hospitals and nursing homes) extend further up to by 2026 registering a CAGR of 6.1%.

Today the aging population of the world is more compare to what it was ten years before. As the aging population is more inclined to health risks like mobility issues, diabetes, cardiovascular diseases (CVDs), and other lifestyle problems. DME or Durable Medical Equipment comes in as a convenient solution for them .while contributing to the acceleration of the DME market.

In fact, a few other reasons that also expedite the DME market are technological advancement and an increase in the prevalence of chronic diseases.

Even though the U.S. DME market is highly competitive, there are still some drawbacks in the DME billing process. DME billing process is nothing but a combination of:

Patient entry- it is where every detail of the new patient is recorded to ensure a seamless DME billing and collection process. Starting from the patient’s name, patient’s Date of Birth, ordering provider’s name, NPI, Tax ID, address, phone no along with insurance information etc. along with excluding fatal and non –fatal documents errors.

Medical Coding - experienced and certified coders ensure a proper check on the diagnosis code here.

Eligibility and Benefits Verification- stringent checking of all the information and verification is done here. This includes details related to the patients and the medication suggested by the physicians that are been provided and then involve providers and insurers to ensure that your client is eligible for claims. Also if the claims have coverage benefits or not etc.

Prior Authorization – it is the most heretic work in the DME billing process where authorization is ensured for the particular medication that can sometimes lead to two to three business days.

Claims Submission- a claim is submitted about the Durable Medical Equipment that is purchased by the patients once all the above processes are already finished.

Rejection Management- when claims that do not meet specific requirements or basic formatting specifications are therefore rejected, affecting the healthcare provider's revenue generation.

Payment Posting-posting of the payments instantly into the respective patient accounts, against that particular claim to reconcile them.

Accounts Receivables Follow-up – when follow-up is ensured with the insurer to inquire about the state of claims submission after claims filling is done.

Denial Management – is when the identification of the errors in the DME billing and collection is corrected and steps are ensured.

Problems faced in a DME billing process:

Costly affair - non-clinical staff are paid more than the federal minimum wage of $7.25 an hour, according to the HME News poll.

In fact, a starting wage between $11 -$15 an hour are been paid to these non-clinical staffs are reported by 62%, which is quite an expensive affair. This is why people today are more comfortable in outsourcing their DME billing services as it not only eliminates extra employee payment but also overall reduces the operational cost.

Billing and coding errors due to Inadequate billers and coders- it is often seen that the DME billing and coding process not only encounter missing, incorrect or duplicate information that has been provided but also incorrect codes, PIN or NPI given being a common problem in the DME billing and coding process.

With incomplete Demographic Information and missed filing deadline, we often see that the DME billing process ends up with a list of denial claims.

Usage of backdated software and no technology advancement– inadequate information about the DME billing process and lack of software awareness are also one of the biggest problems in the DME medical billing process.

Backlogs formation – in a DME billing process backlog formation due to the struggle with payment posting, the long prior authorization process is very common, especially when the healthcare provider lacks expert billers and coders.

However, today resolving all DME billing issues is no longer a problem when there is Sunknowledge Services by your side. Offering a seamless billing operation that involves a reduction of operation cost, robust reporting, etc Sunknowledge Services also has excellent industry references.