DME Billing Habits that are Crippling Your Practice

The Durable Medical Equipment (DME) industry has seen steady growth in the last few years. Along with the increase in the aging population and the prevalence of chronic conditions, the demand for such equipment has risen. However, you might have observed that though there is a steep growth in the market, your practice is not earning the revenue it should. A major reason for this is poor DME billing management. The frequent changes in medical billing and coding regulations, and keeping track of the same while maintaining clinical responsibilities, have become a nightmare for the providers.

With the increasing volume of patients and complex administrative tasks at hand, even your best staff can pick up the bad billing habits that create bigger problems.

4 Bad Habits Ruining Your DME Billing

1. Too many not-on-file claims: You are a DME provider and are following up on a 45-day-old claim. The claim just hits the queue for follow-up, and you ask yourself, “Do I have the proof that the claim was accepted by the insurance provider? Did I get a response?” You call the company, and they say the claim is not on file.

Complete disaster, right?

When your claims are not getting filed with the insurance company, you have no chance of being reimbursed. Many times, claims that are not on file are denied by the insurers, resulting in revenue loss.

2. Losing track of unpaid claims: With a huge patient volume it is quite common for the providers to lose track of the unpaid claims. If these small claims start to pile up in your accounts receivable bucket, in no time you will face adverse financial and functional consequences.

3. Not having a structured outreach process: You get a referral from a hospital. You can infer from the referral that Ms. Jones requires oxygen and is being discharged. Most of the time, an official form needs to be signed once you’re given a prescription and certain medical records. But Ms. Jones is already leaving the hospital, so you need the DME equipment as quickly as possible. Ms. Jones receives delivery of the equipment.

The order then becomes a claim that is placed on hold since a signed document, such as a doctor’s certificate of medical necessity, is still required. You start calling the doctor after the claim gets stuck in queue and is not resolved, but they are unable to locate any medical documents. Once the follow-up is scheduled for three days later, the claim is sent to Neverland.

4. No having an internal feedback loop: An authorization not on file remains at the top denial for six months in a row. The front end and intake team are not being immediately made aware of any product/equipment and payor combinations triggering these denials, so the issue is not being resolved upstream.

Eliminate Bad Billing Habits with a DME Billing Expert

Navigating through DME billing is a complex maze and it creates an administrative burden on your staff while they are busy providing clinical services. However, we at Sunknowledge Services Inc. have created a defined medical billing and coding approach that will transform your ROI in no time.

Our cutting-edge solutions provide you with the streamlined DME medical billing and coding processes that reduce claim denials and errors. Because of the continuous training provided by major health insurers, we have been ahead of the curve for more than 15 years. We oversee claims across more than thirty specialties, including radiology and cardiology, with unmatched accuracy.

We are happy to be the only RCM service that works with payors and providers, offering several well-known brands in the industry special benefits including committed account managers, a 10% buffer in workforce allocation for ongoing billing, and specialized resources.

We are also happy to provide references from every state. For a cutting-edge, effective approach to managing AR, prior authorization, coding and other matters – that has been honed over more than 15 years – choose Sunknowledge.