Streamlining Ways to Effectively Appeal DME Billing Denials

Achieving higher collections from Durable Medical Equipment (DME) billing is crucial for ensuring financial stability in the healthcare industry. And efficient billing procedures require a specialized understanding of DME medical billing.

Today more than 63% of the US population use products and accessories belonging to this group of medical equipment. DME encompasses devices and equipment prescribed by healthcare professionals to aid patient recovery, and intended to last for at least five years. Some typical examples include oxygen tents, nebulizers, CPAP machines, catheters, hospital beds, wheelchairs, and various other healthcare related items. However, even with so much demand, DME providers often struggle to maintain their profitability due to persistent revenue losses and delayed collections due to changing regulations and other associated complexities of the billing process. All this can disrupt the billing transaction, and at times, can also lead to inadvertent fraud.

Needless to say, the importance of adopting effective measures to minimize such unpleasant outcomes while dealing with DME billing complexities cannot be overemphasized. The best way to streamline DME billing is to have a specialized expert managing it all while aiming to optimize collections. In this regard, Sunknowledge Services Inc. is a name that shines bright in the realm of DME billing. With proven ways to enhance the efficiency of billing procedures and ultimately improve financial outcomes for DME healthcare providers, Sunknowledge has been at the forefront of lending complete Revenue Cycle Management support.

6 Useful Tips to Improve DME Billing Collections

Fluctuating DME medical billing criteria and varying payors’ medical coverage norms can lead to an increase in claim denials for your practice. To maximize claim collections, here are a few top recommendations for appealing DME claim denials with efficacy.

1) Redetermination – When appealing a DME claim denial, avoid submitting documentation with errors, as this indicates carelessness and leads to further denials. Ensure that your appeal letter and all supporting documentation are error-free by following the prescribed guidelines

  • Verify that medical documentation is accurate, appropriate, and relevant
  • Ensure that both current and past diagnoses are correct and supported by medical records
  • Confirm the accuracy of Healthcare Common Procedural Coding System (HCPCS) codes
  • Include an authorization approval number on the claim
  • Accurately apply any modifiers for unique conditions or situations DME products

2) Reconsideration – Many clinics simply resubmit the same claim with additional evidence, hoping the insurance payer will reconsider. However, this approach often wastes time. Instead, submit a formal appeal letter directly to the payor. Although this may take longer than a straightforward resubmission, it offers several advantages:

  • Thorough Investigation: A formal appeal compels insurers to investigate your claim more thoroughly and address it faster than a simple resubmission
  • Efficient Filing: Many insurance companies allow you to appeal through their official website. Utilize this service to file appeals as efficiently and securely as possible, and track the progress of your appeal online
  • Serious Consideration: A formal appeal letter demonstrates that you take the claim denial seriously. Drafting the letter also provides an opportunity to thoroughly evaluate the claim and its supporting documents, increasing the likelihood of a favorable outcome

3) Timely Submission of Claim Appeal – Submitting a proper claim appeal letter promptly is crucial. The quicker your claim is processed, the sooner you receive payment for the provided equipment, alleviating any concerns for your patients as well.

4) Adopting a Proactive Approach – Being proactive in appealing DME claim denials involves more than just ensuring accurate coding and obtaining necessary signatures, though these are essential. Anticipate potential reasons for claim denials and prepare accordingly.

5) Understand Different Claims Processes – Each payor has distinct policies for the claims appeals process, including varying methods, deadlines, and restrictions. Keep an updated record of the claims appeal procedures for each payor. Additionally, document reasons for claim rejections to improve future submissions.

6) Maintain Open Communication with Patients – Maintain transparent communication with your patients about potential fees if their claim is denied, how they can assist in the appeals process, and how they can help clarify any inaccuracies in your paperwork. For example, if a patient’s record lacks sufficient information about their major complaints and previous treatments, discuss this with them during a visit. They might connect you with a previous provider who can supply the necessary information for your appeal.

Enhance Your DME Collections

To reduce claim denials, leverage advanced technology and expertise in medical billing and Sunknowledge is your one stop destination. Our specialized DME service – which is designed to work on all major DME billing software systems – centralizes all your information, ensuring timely compliance with providers’ insurance claim processes. Additionally, our DME billing and compliance experts possess extensive experience in contesting claim denials. With constant follow-ups, checks and audits, the utilization of the right DME billing software and proper management, we have providers who have achieved an over 90% claim clearance rate. So get in touch and see how our experts can make a difference.