Neighbor News
Time to Improve Your DME Billing Denial Claims
While 90% of denials in a DME billing claims can be avoided if careful measures are taken, it is important for the healthcare providers.
A denial claims in a DME billing industry result in a loss of 3% of the overall net revenue for healthcare practices, according to a research. Moreover, even with a strong denial management team, we have often seen that one in five service claims formed by in-house billers being declined or denied for which the reworking on individual claims comes up to USD 25 per denied claim. Leaving healthcare practices over the country to spend approximately $262 billion per year on denied claims from insurers, sparking a huge cash-flow problems and recovery costs.
However two-thirds of the denied claims recovered can be reduced as more than 80% of denial claims in the DME billing process is preventable, as 30% of denials in the DME billing process are the result of front-end inefficiencies according to a research.
In fact, the root causes of the denial claims are considered to be an administrative issue but clinical factors are equally responsible. This happens especially when in-house billers are seen juggling in between the demands of treating patients and handling billing issues. This is why operational extensions take the responsibilities of helping healthcare practices so that healthcare practices can focus on patients care and reducing the DME billing denial rate.
Tips to reduce your denial claims for DME billing process:
Proper eligibility and authorization verification check- one of the primary reasons for claim denials is billing a non-covered or ineligible service which often been missed out in the eligibility and authorization verification process by the in-house billers. In fact, researches have shown that almost 75% of denial claims are due to this ineligibility. It does not end here complex rules associated with individual payers also contributes a vital part in the denial claims process. However, all this can be avoided, if all the information and details are effectively collected and verified properly by a proper team of expert billers and coders by the outsourcing organizations. As in-house billers often are seen missing out on this information due to the work overload.
To ensure complete information is received- small error in the DME billing process, inaccurate demographic data address can result in claim denials and pile up the backlog. This is why outsourced experiences billers and coders are preferable, as they ensure complete information; which in-house billers lack in the pressure of doing other administrative work.
Ensures proper coding – codes in a DME billing process is essential not only in ensuring the service or the details of the medications but also playing a vital role in the claims process. Since a single coding error not only results in denial of claims but a long process of rework.
While 90% of denials in a DME billing claims can be avoided if careful measures are taken, it is important for the healthcare providers to understand that every step in the DME billing is accurately performed in order to harness maximum claim benefits. However, today outsourcing is the best option as it not only frees up your administrative work so that healthcare providers can focus on patient care but also it’s a cost-effective solution ensuring reduced denial claims rate with its stringent check and teams of experts billers and coders.