Revealing the RAC Techniques of DME Billing

Is your staff aware of RAC issues? Is your practice facing revenue losses due to inefficient DME billing?

Finding and fixing incorrect payments for medical services rendered to Medicare beneficiaries in all 50 states is the goal of the RAC and the Centers for Medicare and Medicaid Services (CMS). Both overpayments and underpayments may be apt examples of these incorrect payments.

It is important to understand that you too may have contributed to ‘Reservations Against Collection’ problems if you bill for any of the goods below or have billed for any of them in the past!

Currently, there are 16 RAC issues listed. 8 issues will follow the automated review process, while the other 8 will go into a more complex review process.

Above all, automated reviews of underpayments are related mostly to Group 3 power wheelchair options. The goal of this case is to recoup improper supplier reductions caused by Section 2 of the Patient Access and Medicare Protection Act (PAMPA).

Approved RAC Issues for DME Billing

  • Nebulizers/related accessories or medicine
  • CPM Machine: Tracheotomy Suction Catheters, Suction Pumps, Catheters and Other Related Supplies/Equipment
  • Chest wall oscillation services
  • Osteogenesis stimulators
  • Group 2 Support Surfaces without Correct Diagnosis of Condition
  • DME billed while being in an inpatient condition
  • Glucose Monitor when billed with the same date of services as Glucose Monitor Supplies (Unbundling)
  • Excessive Units of Spring Powered Devices Billed for than one in 6 months
  • Multiple DME rentals in one month
  • Hospital beds equipped with Group I or Group II support mattresses for billing
  • Complex Comprehensive Negative Pressure Wound Therapy Pumps
  • Complex Blood Glucose Monitors with integrated Voice Synthesizer billed without indicator of medical necessity
  • Group 3 Power Wheelchair Options underpayments

Leverage the Sunknowledge Opportunity

As DME billing is a specialized field, it requires extensive knowledge and understanding of coding and billing guidelines. Managing the RAC issues and their impact can be reduced if you can balance clinical and administrative tasks simultaneously. But this often turns out to be an impractical proposition. We are here to help you. With 100% HIPPA compliance, our experts can reduce your overhead expenses by 80% almost immediately at a highly affordable cost. Our team of expert medical billers and coders can handle all your administrative processes, leaving you to enjoy a clear work-life balance. With experts well-versed in technology, we can work on different software systems with maximum efficiency.

Reputable DME billing companies like us can come up with a great plan to minimize your problems with DME eligibility verification, order input, validation, and prior permission for proper filing of claims, ensuring fewer or no denials. Making sure all expenses are mitigated, outsourcing can be considered as a strategic option for most of the providers within the country.