Turning Your DME Billing Denials into Dollars

It is a no-brainer that fewer denials mean a more profitable balance sheet for any healthcare practice. The Durable Medical Equipment (DME) industry today is seen operating with a fragile financial Charge Sheet. This is largely because, with the rising demand for DME products, billing and coding errors have always increased. And a major cause of this is the intrinsically complex nature of DME billing.

All about DME Denials:

Typically, the standard benchmark for DME (Durable Medical Equipment) billing denials in dispensaries is set at 2%. Any percentage between 5% and 10% is deemed cautionary. However, a recent survey has revealed that one in every five claims undergoes either revision or review, accounting for up to 15% to 20%. Denied claims not only disrupt the financial cycle but also require extra resources and time to resolve. To ensure financial viability, healthcare institutions must excel at converting these denials into revenue by maximizing recovery efforts from denied claims.

Steps to Recover from Denials

In this competitive age, revenue recovery from denied claims and ensuring a seamless DME billing process can be a real challenge. Here are a few strategies that will help you with complex denial claims.

  • Instant Eligibility Verification Management – One should ensure real-time eligibility verification to validate patient insurance coverage and benefits before service provision. This proactive approach will not only help detect potential issues in the early stages of the billing process, but further mitigate eligibility-related denials later on.
  • Thorough Scrutiny of Claims – Establishing a robust claims scrubbing process that meticulously reviews claims prior to submission can make a huge difference. This process can pinpoint and help rectify common errors, such as coding disparities and incomplete data, before forwarding claims to Payers, thereby reducing the hassles of running behind denied claims.
  • Comprehensive Documentation – Advocate for thorough and precise documentation. Clear and detailed clinical notes serve as valuable evidence when contesting denied claims, showcasing medical necessity and service appropriateness.
  • Denial Analysis – Harness the power of data analytics to uncover patterns and trends in denials. By pinpointing the underlying causes of denials, organizations can enact targeted enhancements to processes, thereby reducing future occurrences of denials and ensuring a better reimbursement process.
  • Instant Follow-ups – A prompt follow-up on denied claims underscores a robust denial management workflow. The sooner you address your denials, the higher the likelihood of successful recovery is.
  • Constant Training and Development – The foundation of effective DME revenue recovery starts with a well-trained and well-informed staff. This is why one should ensure updated billing and coding teams on coding guidelines payer policies and more. The right training will only reduce the rate in errors that lead to denials.
  • Collaborate with Payers – Establishing an open line of communication with Payers can help resolve issues more quickly and lead to improved claims processing.

As denials play a vital role in determining the success of a DME billing practice, maximizing revenue recovery from denied claims to ensure financial resilience needs expert solutions. In fact, the implementation of proactive measures to avert denials, and reactive approaches to tackle all denials, need experienced people. DME experts like us become indispensible in this context.

  • Tracking your denial rate – For better understanding, monitoring the percentage of claims gives our experts an idea of the overall RCM cycle to work on the problems.
  • Days in Accounts Receivable (A/R) – Sunknowledge experts ensure a minimum 30% reduction in your A/R bucket within the first month itself.
  • Clean Claim Rate – With constant follow-ups and the right checks and balances in place, our experts work on error-free and timely claims submission on the first attempt.

If you are looking for an expert to manage your DME billing complexities – be it claims or DME prior authorization – Sunknowledge is your preferred destination. Let us help you reduce all your billing woes in the shortest time and improve your overall financial performance.