How Denial Claims in DME Billing Process affecting Your Practices

Working on denied claims can be a frustrating and time-consuming process at times, as closing the claims requires expert attention and care to ensure correct patient information, treatment and diagnostic codes and even complete billing rules and insurance regulations knowledge. In fact, researches are there stating that these denials claims result in the loss of a predicted 3% of the overall net revenue for a healthcare provider.

As getting your DME claims submitted and paid correctly on time requires tapping all the needed details carefully for the process, it becomes challenging for many healthcare practices.

Though almost every healthcare provider have effective denial management programs, yet one out of five service claims generated by them generally get rejected or denied. In fact, according to a survey, the most common grounds for denial claims in DME billing process can be listed as:

• Incomplete Demographic Information
• Missing or invalid information
• Lack of Demonstrated Medical Necessities
• Incorrect/missing CPT code, modifier, PIN or NPI
• Claim Not Included As Bundled Payment of Managed Care Programs
• Duplicate claim or service

However, a positive side to this situation is almost 90% of denial claims in your DME billing process are preventable. In fact, two-thirds of the denied claims in your DME billing process can be recoverable, if proper attention is paid during the front end billing process. In fact, 30% of denials are a result of front-end inefficiencies. This is why if much attention is given to the initial billing part, healthcare providers won't have spent thousands and thousands of dollars dealing with such a large number of denial claims in the first place itself. Further, according to the survey by Remit Data, it is seen that one of the top five reasons for denial claims in the DME billing process is related to the front end issues.

A significant hurdle in this area is that healthcare practices even today continue to view denial management as a back-office problem alone. This is why rather spend lump of money n denial claims one should outsource their front end DME billing process.

Today, in fact, there are many such Revenue Cycle Management organizations that not only offer pre-billing services but have the benefits of post billing services too on an ala carte basis. Helping in reducing your operational cost by 70%, these Revenue Cycle Management organizations also ensure the highest collection rate and productivity metrics too.

With a well-equipped team of medical billing and coding experts and complete knowledge of all the billing process, industry mandates, software and the billing rules and regulation; they even offer robust reporting customized as the client’s requirements.

Helping with lesser denial rate in your DME billing process, there are Revenue Cycle Management organizations today offering a FREE Telemedicine platform to increase the volume of your patient’s intake.