How to Tame Your Denials – A Blueprint for Effective DME Billing and Revenue Cycle Success

In the intricate web of healthcare management, a persistent challenge continues to haunt medical practices— the issue of denials. A recent poll by the Medical Group Management Association (MGMA) unveiled a startling truth: 69% of healthcare leaders experienced an uptick in denials in 2021. The reasons behind this surge are diverse, including non-reimbursement for COVID-19-related supplies, critical care claims, and imaging CTs. As denials make their presence felt and most DME providers are today feeling quite overwhelmed there are medical practices are at a crucial juncture—to dive deep and address the underlying causes behind these roadblocks.

In fact, today more and 64% of DME providers are looking for solution to reduce their denial rate as if carefully address the three denials claims out of five can be easily avoided. And so being in the industry for 15 + years and serving the top three DME clients in the US and address their pain points, we are here to share few tips that can help you with the same.

How to avoid denials for your DME billing -A Stark Reality

Denials are not just a minor inconvenience; they have become a looming challenge in the world of healthcare. Change Healthcare’s 2020 Revenue Cycle Denials Index reveals a concerning trend: the denial rate has escalated by 23% since 2016, with an additional 11% spike post the onset of the COVID-19 pandemic. While the pandemic did play a role, the fundamental causes and origins of denials have persisted over the years.

In fact Ronnie Hasting our AGM emphasizes the significance of addressing issues at the front end.

Bolstering the Front Line: strategies to combat denials

• Precision in patient data: The journey to curbing denials commences at the beginning—with accurate patient data. Ensuring accuracy during pre-registration and registration is paramount to averting downstream complications.

• Regularly update yourself: Always be up to date, ensuring that charges are meticulously accurate. This step serves as a bulwark against discrepancies and potential denials while billing for the DME.

• Harnessing claim edits & billing software: Verify the efficiency of DME billing software and claim edits. This ensures seamless processes and diminishes the risk of denials.

• Seamless rejection report communication: Forge clear channels of communication for rejections outlined in reports. Swift implementation of corrections is key to minimizing claim delays in your DME billing process.

• Confronting internal hurdles: Internal challenges often lay the groundwork for denials. Address issues such as resource scarcity, staff attrition, and denial backlogs to thwart the deluge of rejections by 93% in a DME billing process.

• Technology advancement: Embrace technology optimization, infusing automation into clinical documentation processes. Invest in analytics and AI to keep pace with regulatory changes.

How Sunknowledge Revolutionizes DME Denial Management and ensure Financial Recovery

Denials, when unaddressed, come at a cost—the average expense of reworking a claim stands at $25.20. However, there’s a silver lining—the majority of denials can be averted. Astonishingly, a whopping 86% of denials are potentially preventable. This revelation underscores the urgency of deploying proactive measures and strategic strategies.

Pioneering transformation with proactive approaches

• Analysis & identification: Gaining insight into errors and bottlenecks is the first step. This analysis unveils denial root causes and their impact on the revenue cycle.

• Focus on key areas: Direct efforts toward registration/eligibility, authorization/pre-certification, medical necessity, accurate medical coding, claim data validity, and services not covered.

• Improve communication: Equip front office staff to inquire about additional coverage and ensure eligibility before claim submission. Vigilance in tracking patient insurance details is paramount.

• Stay ahead of authorization: Prioritize a comparison of authorized services with ordered and performed ones before the service. Swift communication with physicians and payers guarantees precise authorizations.

• Validation of medical necessity: Engage in peer-to-peer meetings, submitting complete clinical documentation for ongoing stays. Document the severity of the patient’s condition comprehensively.

• Precision in medical coding: Focus on precise discharge status coding and comprehensive documentation of patient health status.

• Claim scrubbing: Ensure the absence of duplicate claims, missing payer IDs, procedure codes, and invalid diagnosis codes. Sunknowledge’s claim scrubber ensures impeccable edits.

As denials continue to challenge the healthcare sector, medical practices must take decisive action. By implementing robust front-end processes, leveraging advanced technology, and building internal resilience, practices can effectively mitigate the impact of denials. Sunknowledge brings profound understanding of denial causes, focusing on prevention and strategic intervention. If you’re experiencing significant financial losses due to denials, contact us for a free, no-obligation consultation to explore how we can assist you.