- October 13, 2022
- Posted by: David Smith
- Categories: DME Billing, DME Billing Services
Understanding Denials in HME Billing
Denials are not uncommon in the realm of medical billing. Most providers face them every now and then. It is true for HME billing, too. The main problem with denials is not their persistence in the scheme of affairs, but their proliferation over time. Let me explain. While most providers need to accept some amount of denials in their HME billing efforts, too many of them, or too frequently, can pose a grave threat to the overall health of their collections.
So why do denials in HME billing multiply? And what can one done to keep the count down? These are the questions that face every HME provider. However, the answer is not a hard one to find. If one were to really get down to the bottom of things and do a root-cause analysis, it would show that denials mainly result from a failure to meet the specific requirements of the payer. In other words, they stem from a failure to satisfy the specific needs of the payer that would allow for an undisputed reimbursement of the claim forwarded by the provider.
Understanding these requirements, therefore, is crucial to making a claim go through. One of these, in a broad manner of speaking, is establishing the medical necessity of the prescribed equipment. For this, the provider needs to supply all the requisite supporting documentation that clearly mentions that the prescribed equipment will be beneficial in treating the patient’s condition. Another aspect is coding correctly that should include everything (including all accessories and supplies, and not just the core device) and being accurate (in mentioning for which specific part of the body the use of the equipment is intended for).
Reducing Denials in HME Billing
It is evident that effective denial management and bringing down the denial rate need specialized knowledge and skill. This is why a large number of HME providers are seeking out professional intervention to streamline their billing and collections. When it comes to HME billing, there are some great names to consider for outsourcing. They not only provide excellent billing support at a very affordable cost, but also effectively bring down denial rates, increase collections and leave more free time to the providers to devote to actual patient care.
Specialized and dedicated third-party intervention in billing & collections comes with a host of benefits. Providers usually enjoy faster claims processing as contracted billers are dedicated to billing only, and not given to multi-tasking. And, of course, you can expect fewer obstacles in your billing path as they adopt the best medical billing practices for the best outcome.