Sunknowledge Helps DME Company Streamline Prior Authorization and Increase Revenue

Client requirement and challenge

A highly reputed and third-largest Durable Medical Equipment (DME) practice in the US faced challenges in obtaining timely authorization. They were keen to maximize the earning potential by reducing the practice expense and were looking for ways to improve the authorization process and the bottom line.

Analysis the problem: Our evaluation

Conducting a comprehensive internal audit, our initial evaluation revealed that inaccurate coding and documentation crises were the primary issues, causing delays along with late reimbursements. A few of the reasons we discovered were

➣ Insufficient documentation of patient
➣ Incorrect HCPCS (Healthcare Common Procedure Coding System) codes for DME products
➣ Inadequate information about the prescribing healthcare provider
➣ Slow responses to coding-related inquiries from the DME supplier, leading to further delays in claim filing
➣ Absence of digital signatures by healthcare providers

The Sunknowledge solution

As we transitioned the DME billing processes to our team, we developed a comprehensive transformation plan in collaboration with our in-house DME expert where our goal was to achieve all-round improvement by addressing all existing issues and helping the practice enhance reimbursements. Our team implemented the following solutions:

DME Documentation and Coding Audit:

➣ Reviewed DME documentation for accuracy and ensured the billing team communicated efficiently to reduce issues related to documentation
➣ When documentation was incomplete, the supplier was notified to update and share the records within 24 hours
➣ Discussed the significance of accurate HCPCS codes for DME products and emphasized the importance of complete documentation, including medical necessity and provider details
➣ Shared daily and weekly analyses of trends on missing or incorrect components in DME claims
➣ When the HCPCS code for a DME product was incorrect, we either queried the supplier for accurate details or coded the product at the lowest level. We discussed such scenarios monthly with the client to improve policies and procedures.

Authorization checks:

➣ Ensured 100% authorization submission on the same day and showed how it can lead to better reimbursements
➣ Set a standardized 24-hour turnaround time and follow-up plan for better results
➣ Worked on closing DME prior authorization gaps not only faster but more efficiently by ensuring constant checks and balances

Final Outcome:

By partnering with us
➣ to reduce authorization complications
➣ streamline DME billing and coding processes
➣ address inadequacies

the Client witnessed
➣ Reduced number of accounts pending due to incomplete or incorrect documentation and coding, from 23% in Nov-22 to less than 1% in Feb -23
➣ Lowered DME-related denials from 10% in Nov -22 to less than 2% in Feb -23
➣ Issues related to DME documentation and coding problems successfully addressed, and timely authorization ensured
➣ Elimination of the problem of delayed filing due to a lack of digital signatures
➣ Increase in monthly collections from $10,000 in Oct-22 to $120,000 in April-23

Time to partner with Sunknowledge:

Sunknowledge is a leading one stop RCM destination with 16+ years of experience in managing complex billing and coding problems for many leading names in the industry. Today, we have more than 100’s of happy clients, a feat that we have achieved not only by successfully helping them scale up their businesses, but also ensuring a greater inflow of revenue for them. We operate on a completely transparent service and support model so that you have a clear understanding on how we work and stay in control. We also provide services in patient demographic entry, CPT & ICD-10 coding, accounts receivable services, claims management and more. For more information, get in touch today.