A Blueprint to Reduce DME Billing Denials

It is no secret that claim denials are a significant challenge in the healthcare cost reimbursement industry. A 2021 poll by the Medical Group Management Association (MGMA) found that 69% of healthcare leaders saw an increase in denials. And the reasons for these denials mostly include non-reimbursement for critical care claims, errors in documentations, and mismatch in codes. Today, 3 out of 5 denials end up being final and irreversible, and therefore, addressing them is crucial for medical practices.

The Growing Problem of Denials

Denials are more than an inconvenience; they are a major issue with a potential for causing much damage to the reputation and financial health of a DME business. Change Healthcare’s 2020 Revenue Cycle Denials Index shows that denial rates have increased by 23% since 2016, with an 11% spike during the COVID-19 pandemic. Despite the pandemic’s impact, the core issues causing denials have remained consistent.

Nick Raup of e4health has highlighted in a recent report that registration and eligibility problems, accounting for nearly 27% of denials, are a primary issue. Authorization/pre-certification issues cause 11.6% of denials, and 10.6% are due to services not covered. Notably, half of all denials originate from early-stage problems.

Here are a few strategies to reduce your DME billing denials instantly:

1. Accurate Patient Data: Ensure precise data during pre-registration and registration to avoid issues later.
2. Update Chargemaster: Keep the chargemaster current and accurate to prevent discrepancies.
3. Use Billing Software and Claim Edits: Ensure billing software and claim edits are up-to-date for smooth processes and fewer denials.
4. Clear Communication for Rejections: Establish clear channels for addressing rejections quickly to minimize delays.
5. Address Internal Issues: Solve problems like resource shortages, staff turnover, and denial backlogs to reduce denials.
6. Adopt Technology: Use automation in clinical documentation and invest in analytics and AI to keep up with regulations.

Tips to Prevent Denials: Financial Benefits

The cost of reworking a claim is $25.20, but 86% of denials are preventable. Taking proactive measures can significantly reduce denials.

Proactive Strategies

1. Analyze and Identify DME billing errors: Understand denial root causes to improve processes.
2. Focus on Key Areas: Improve registration/eligibility, authorization, medical necessity, accurate coding, and claim data validity.
3. Enhance Communication: Train staff to check for additional coverage and ensure the right DME eligibility before submitting claims.
4. Ensure Accurate DME Authorizations: Compare authorized services with what is ordered and performed, and communicate promptly with physicians and payers.
5. Validate Medical Necessity: Hold peer-to-peer meetings and submit complete clinical documentation.
6. Precise DME Coding: Ensure correct discharge status coding, a current chargemaster, and detailed DME billing documentation.
7. Effective DME Claim Scrubbing: Avoid duplicate claims, missing payer IDs, procedure codes, and invalid diagnosis codes.
8. Manage Uncovered Services: Collect upfront payments for Medicare patients and secure signed Advance Beneficiary Notice (ABN) forms.

Sunknowledge: The Better Way to Reduce DME Billing Denials

Taking care of the complete DME pre and post billing operational cycle, our experts work on addressing all the root causes of DME denials. Focusing on prevention, and implementing strategic measures, Sunknowledge is well-known for effectively reducing denials, safeguarding revenue, and enhancing financial stability in a remarkably short time.

Partnering with us for your DME billing tasks guarantees a consistent 99.9 % rate of accuracy, faster reimbursements, 100 % DME prior authorization requests submission in the same day, a minimum 30% reduction of your aging AR bucket and more at only $7 an hour.

For more information on how we can change the tables in your favor, get in touch with our experts today.