Solving the Prior Authorization Puzzle in DME Billing

Navigating the prior authorization services in durable medical equipment billing can be tedious and challenging. Prior authorization in DME billing is one of the most intricate processes that increase the complexities in the billing process for DME providers. To create a holistic DME billing approach, you need to understand the CMS’s PA approach that will pave your path to financial stability.

How Prior Authorization in DME Billing is Changing?

Prior authorization is a major cause of delayed care and reimbursements. If you want to create a hassle-free HME billing approach, a deep understanding of these changes can be useful.

  • The CMS has reformed the PA rules that will reduce patient-care delays and can electronically streamline the DME billing process. This can save practices like yours almost $15 billion in ten years.
  • AMA’s model legislation has been incorporated in numerous bills that will reduce the response time of prior authorization. The reformation has considered that patient-care will not be hindered by PA process. However, some checks will still be in place to counter possibilities where a physician may take adverse medical decisions in case of an experimental approach or if there is no proof of medical necessity. Retroactive denials would be banned in case of preauthorized care.
  • Based on the provider’s performance, the insurers must consider the quality of adherence in case of authorizations. Regular review of the practice’s performance is considered in these guidelines, to reduce the PA approval by the insurers.
  • Gold Card legislation has been considered in Texas and other states, that elaborates if you have 90% PA requests approval rate, you do not need to keep going through the process.

If you are looking for a superior approach that can streamline your DME medical billing services, you need consistent assistance of a vendor who has a detailed understanding of the revenue cycle management and preauthorization process.

Master DME Billing with Sunknowledge

If you are looking for a reliable partner that provides you with dependable assistance in DME billing, get in touch with Sunknowledge Services Inc. We have proven experience in revenue cycle management and can streamline your DME coding and billing process in a really short time. The Sunknowledge team is currently working with over 100 clients in the DME space and has streamlined their practice management with comprehensive knowledge. Also, Sunknowledge is one of the few RCM companies that can boast about working successfully with both Payers and Providers. Our experts understand the dynamic realm of DME billing and coding regulations and can augment your practice management at just $7 per hour. Let us make your revenue cycle transparent, streamlined and compliant with comprehensive US healthcare standards. Contact us today to resurrect your DME medical billing process.