Common Errors With DME Billing Services
One of
the most scrutinized billing areas by Medicare and other commercial carriers is
the Durable Medical Equipment (DME) billing. One of the primary reasons it is
often under investigation is that DME billing Services appear to be anything
but straightforward. Furthermore, the complexities manifolds when healthcare
providers and facilities integrate the DME billing into their
service to increase revenues.
Medicare
has been known to lose more than $60 billion through faulty billing each year,
and part of the waste is due to spending on the DME billing.
If your
practice is losing money due to the DME billing, it is certain that you are
making some errors. You are likely making one of the common errors in the
procedure. We are listing the five most common errors in DME billing services:
1. Patient Verification
In most
cases, DME claims are denied due to wrong information or small error provided
by the CMS or the insurance
provider. For example, a slight change in the name that might look
insignificant or the way a form has been filled up is deemed wrong by the payer
will lead to claim rejection or denial.
2. Errors with Codes
If a
document indicates a different code than that of the billed or serviced, the
insurer will reject reimbursement. Also, a claim will be rejected or denied if
the service is offered by someone else other than the billing provider. There
can be coding errors in medical billing services shown as
unbundled will get the claim denied. Also, even if the beneficiary has been
discharged to another place after the procedure is considered as error. At the
same time, the one in the coded claim is different.
3. Wrong Use of Modifiers
Often
in DME billing, wrong modifiers or a misaligned code can reject the
claim or get denied. Hence, it is vital that when written codes are used for
the service, correct modifiers are mentioned to get the reimbursement for the
service rendered.
4. Necessity of the
Medical Assistance
Once a
medical assistance is done in DME service, the documentation needs
to prove that the billed service was necessary for the patient. If the Medicare
coverage and the insurance providers feel that medical assistance is
unnecessary, the claim will be denied or rejected.
5. Insufficient or
Incomplete Documentation
If
the medical billing documentation provided has inadequate or
insufficient support for the service provided, the payment will be rejected.
The onus is on the service providers to prove that the billed services were
provided and at par with the level billed. Any missed information like a
signature of the physician on the order or an incomplete form that does not
have the date or if each date of service it’s not built separately, then the
claim will also be denied.
Furthermore,
before providing the service, the facility needs to check the number of units
that service can be delivered within a specific time to the member. If the
number of services exceeds the number allowed by the insurance policy, the
claim will be rejected.
How To Ensure There Are
No Errors?
It has
been estimated in medical billing and coding services, out of the
$3.2 billion that goes to waste in the Medicare Trust Fund, $2.6 billion is due
to insufficient documentation. It is essential that proper documentation with
adequate medical coding and correct information is provided so
that it does not lead to claims denial. One of the best ways to ensure none of
this happens is by outsourcing DME billing services to an
efficient medical billing company such as 24/7 Medical Billing Services.
A team
of specialized
medical billers and coders ensures that all documentation,
codes, and modifiers are correct for the claims. Also, they ensure claims are
submitted within the time frame. Additionally, in case of any denials, it is
appropriately followed up. Moreover, with the constant changing in the CMS
rules and regulations, DME billing staff must have in-depth knowledge of the
changes. While at a time, it is not possible, an outsourced partner such as
24/7 Medical Billing Services will ensure that all the DME billing is done as
per the new laws and regulations. So there is no claim rejection, thus allowing
you to have a seamless cash flow and a flawless revenue management cycle for
your DME services. For more information on outsourcing the medical billing
service, contact us today!
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
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