Top 5 Coding Errors for DME Billing
DME
or Durable Medical Equipment is undergoing exponential growth with rising
numbers in the aging population and increasing patients suffering from
respiratory illnesses and sleep apnea. As such population grows along with the
rise in pollution and unhealthy lifestyle; it is evident that the numbers in
demand for DME will soar.
Along
with this growth, the changes in DME billing continue, and it is one of the few
billing systems that is quite complex. However, DME billing is far from being
straightforward when added to the healthcare providers so that the practice
revenues can increase.
In
such a scenario with complex DME billing, it is quite predictable that as a
physician you might lose billions or millions of dollars as revenue due to
erroneous billing.
Here
in this blog we will look into the top 5 coding Errors for DME Billing and
other billing errors that lead to revenue loss.
Top 5 Coding Errors for
DME Billing
The
chances of getting reimbursed for the services provided in DME are pretty
unlikely if the medical documentation submitted by the provider indicates a
different code than the one billed. There are also cases where the services are
provided by someone else instead of the billing provider. Or the service given
is billed but unbundled. The billing codes are erroneous; hence, the claim will
be rejected.
If
the patient has been discharged from a different facility and the coded claim states
about another facility, the billing will also be viewed with the error of wrong
coding and eventually get rejected.
Apart
from these, there is several other factors lead to revenue loss in DME practice
and are counted as one of the major causes of coding errors.
Here
are the top five errors in DME coding:
- A
diagnostic-related group or DRG that drives the HCPCS codes
to be misused.
- The
inaccurate application filled for the fracture and trauma diagnosis codes
with the seventh character.
- Misidentification
of respiratory failure with using the wrong code.
- Failure
to identify and use the correct codes for the guidance tools.
- Insufficient
details with the documentation of components, devices, grafting materials,
etc.
Other DME Billing Errors
In
addition to the above coding errors, there are few other DME billing mistakes that
can often prove quite costly for your practice. Some of these errors which DME
billing usually faces and can be easily mitigated are:
Patient Data Verification
Often,
small mistakes such as the error in the name of the patient provided by the CMS
or insurance provider can lead to claims denial. Hence, it is of utmost
importance that the patient’s details are verified and cross-checked not only
before providing the service but also before submitting the claim.
Correct Modifiers
A
misaligned code and the failure to use the correct modifiers when claiming the
bill in DME can lead to rejection of the payment and denial of it. Hence, a
biller should ensure that the correct modifiers are used for the services
offered.
Showcasing Necessity
When
the service provided fails to showcase the medical necessity in the
documentation set by the Medicare coverage and other insurance providers, the
payment is bound to get rejected.
Insufficient
Documentation
The
insufficient documentation includes the failure to price the services provided.
It can consist of a range of issues such as:
•
Services
recorded are not at the level of billing,
•
The form is
incomplete,
•
Doesn’t have
the physician’s signature,
•
The date of
each service is not given separately
•
The units
offered to the patient are more than allowed within a time as approved by the
insurance company.
Insufficient
documentation has been one of the plaguing problems in DME that causes low or
no reimbursement to your practice. However, it remains one of the critical
lapses among healthcare providers.
Unless
the providers offer the correct codes, modifiers, and other necessary
documents, it will lead to DME claims denial. The DME facilities also need to
keep abreast with the changing CMS regulation, rules, and policies to manage
their claims successfully.
How to get Error Free DME
Billing?
One
of the most viable options to ensure error-free DME billing is investing time
and money in training your staff with the latest DME rules and regulations and
updating the system with the latest RCM tools. However, it can still be a
faulty method at times.
So
the other best way out is to Outsource DME billing
to a competent and knowledgeable medical billing company such as 24/7 Medical
Billing Services. They have been helping DME practices with improved RCM from
decades with their end-to-end medical billing and coding solutions. You can also
be assured that there won’t be any coding errors in your DME billing with 24/7
Medical Billing Services.
About
24/7 Medical Billing Services:
We
are a medical billing company that offers ‘24/7
Medical Billing Services’ and support physicians, hospitals, medical
institutions and group practices with our end to end medical billing solutions.
We help you earn more revenue with our quick and affordable services. Our
customized Revenue Cycle Management (RCM) solutions allow physicians to attract
additional revenue and reduce administrative burden or losses.
Contact:
24/7
Medical Billing Services
Tel:
+1 888-502-0537
Email:
info@247medicalbillingservices.com
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