Make Strides in DME Billing Revenue with Sunknowledge

One of the most scrutinized billing areas by Medicare and other commercial insurance providers is Durable Medical Equipment (DME) billing. One of the primary reasons it is often under investigation is that DME billing services appear to be anything but straightforward. Furthermore, the challenges manifold when there are frequent changes in billing and coding protocols.    

If your practice is losing revenue due to poor billing practices, it is evident that there are errors within the process. We have listed the 3 most common errors in DME billing services concerning the threat to your practice’s revenue. 

Overview of Common DME Billing Errors   

Your practice might lose revenue for plenty of reasons like inadequate or incorrect reimbursements, insufficient or erroneous documentation, lack of eligibility verification and prior authorization, erroneous coding, and so on.    

The Payment Error Rate Measurement analysis by the CMS has identified the most concerning errors in DME billing.   

1. Policy violations: Policy violations occur when billing or payment for the services are not properly documented policy. Common policy violations in DME practice include-

• Claims for DME are submitted to Medicaid, instead of Medicare or other insurance payor. Medicaid is considered the last resort payor, and therefore, reimbursements should be obtained from other insurers initially 
• Documentation without the proper signature of beneficiary or provider that certifies authorized environmental modifications was completed and the equipment was in satisfactory conditions

2. Inadequate documentation: Inadequate documentation occurs when documentation submitted by the provider does not adequately substantiate the services provided. Common documentation errors in DME billing include:

• The dates of service and delivery on the claim do not correspond with the dates on the documentation that was given 
• Documentation did not support the billed services, physician orders, delivery tickets, and invoices are missing, and coding on documentation does not match the codes submitted on claims

3. Number of unit errors: Quantity of units when a provider bills for a procedure code’s erroneous number of units, mistakes happen. Common mistakes with DME include:

• Inaccurate unit calculations 
• Inconsistencies between the number of units billed and the number of units received by the beneficiary as stated in the documentation

For instance, one unit is equal to one item under process code A4520-Incontinence clothing, any type. Items are supplied in several units, albeit the quantity of adult diapers in a case may vary depending on the size of the item. The delivery ticket stated delivery of 288 units (48 units per case times 6 cases), however, the service billed for 360 units (60 units per case times 6 cases).   

Make Your DME Billing Flawless with Sunknowledge   

A team of specialized DME billers and coders can assist you with your DME billing and coding issues at Sunknowledge Services Inc. We have been Fulfilling an unparalleled service for many of the largest providers in the country for a decade.

Our solution is cutting-edge and competitive without sacrificing industry standards. You can rely on team of experienced, and expert billers and coders to help you with your RCM.

Providers and practices need to understand the complex relationship between DME Medical billing and revenue and patient outcomes in today’s rapidly changing healthcare environment. By implementing best practices in DME revenue cycle management, healthcare facilities may ensure a sustainable and prosperous future in addition to achieving financial stability and providing exceptional patient care.