How To Deal With Denials In DME Billing?
Rejections
and denials of claims in DME billing greatly
impact reimbursements and cash inflows of a DME billing company, and it hits
directly the revenue cycle management process. With CMS bringing in close
investigations on DME services, the relevant companies are to restructure their
business concerns and activities. This helps them in streamlining their
processes and improving their revenue as well. But the foremost thing to think
of would be why such denials/rejections happen for most DME billing services.
This blog can guide you with certain points as a checklist to
understand why denials happen in general and how to deal with it before it goes
to rejection.
#1: Check eligibility
criteria for patient and do proper verification
The
staff responsible for sending the applications for claims of a DME
billing company should primarily focus on whether the
patient is insured or covered for DME services and what are the eligible DME
services for them. This checking is crucial and sometimes, spellings of names,
incorrectly checked information box, etc. can be the reasons for a claim
denial.
#2: Coding and modifiers
An
invalid or a missed modifier can lead to immediate rejection of claims. To
avoid this, you should keep a standard chart that notifies on correct codes and
modifiers to your medical coders and billers. Whenever there is an
addition/update on the coders and modifiers ensure that it is immediately
reflected on your chart and your employees are informed about it.
#3: Documentation
Documentation
is the next crucial one, which could lead to denial of claims when it is not
sufficient or incorrect. Proper documentation has to support the medical
necessity of any DME product prescribed. This acts as a helping hand not only
during claims but also in audits to prove the claim is correct.
Every
order should contain an indication of diagnosis/reason for using the
equipment/medication, correct date, and the DME provider’s signature. Missing
out any one can lead to rejection of claims. Therefore medical billers and
coders should be very careful with documentation.
#4: Process and workflow
Before
your initiate claims, it is important that you check and know about your
internal processes, workflows and functionalities. If you identify a problem
persists in the process by itself, changing the way you work, can save your
time and effort of applying claims and receiving rejection status on them.
You
can work out a dedicated and unique strategic plan for streamlining your DME
billing process by creating a checklist for the key points
aforementioned. Sorting out this points one by one will always keep you one
step ahead and support you with reducing rejections/denials in DME billing
claims.
You are not too late to
follow certain processes to make your DME billing and workflow process
streamlined. See if the following points can help you achieve your goal of
reduced denials of DME bill claims.
- Revolutionizing and rebuilding your
processes and organization structure can keep your staffs intact with the
new rules and procedures.
- Updating the existing technology and
adopting new platforms help in keeping processes in one direction and make
you realize the pain point as well.
- Outsourcing your entire DME billing
and claims process to an expert company can literally get the denials down
and ensures smooth cash-inflows.
Conclusion:
24/7
Medical Billing Services is a medical billing and coding company
that works rigorously and vigorously to get your claim reimbursements on-time.
The company is well-known for achieving the maximum number of claims without
encountering any rejections/denials in claims processing. Contact 24/7 MBS team
if you face difficulty with reimbursements or have high volume of tasks to be
completed.
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