Today medical technology advancement along with the rising rate of chronic diseases such as kidney failures and cancer is not only the cause of the expansion of the DME billing market but also the increasing rate of the aged population playing the maximum contribution. As people above 60 and more are more prone to issues related to health problems like diabetes, mobility issues, cardiovascular diseases (CVDs), and other lifestyle and mobility problems; creating a separate niche for the DME products like walkers, wheelchairs, canes, crutches, oxygen, and respiratory equipment, etc. Bathroom equipment, communication, and speech-generating devices, infusion equipment and supplies, traction and trapeze equipment, etc also fall under the DME types of equipment.
Being different from other medical billing processes, DME billing requires extensive in-depth knowledge about the DME process knowledge, a complete understanding of the industry mandates, and the complex HCPCS Level II codes; as all DME is classified under the HCPCS level II codes.
As even a single mistake in the coding process of DME billing or even delayed submission of claims can cause a huge problem in receiving the reimbursement that the healthcare provider deserves. This is why a person during the DME billing process has to be fully aware of every specific code and the coding process should be carefully done. However, a complex reimbursement further adds up to the challenges in the DME billing process.
How the DME billing and coding processes work:
The DME billing and coding process can mainly be divided into two important parts pre and post billing:
The pre-billing steps start when the physicians prescribe the DME products to the patient, all the data about the patient is documented which is known as data entry, and the initial step of the DME billing process. This is Followed by Eligibility Verification and prior authorization process where stringent checking undergoes, where the patient is applicable or not, and permission for the DME products is initiated. Once this is done, the coding process starts where identifying the correct HCPCS Level II codes is involved along with and stringent check of every accessory and piece of the equipment is coded properly; the DME biller gets started with the claims submission process once the coding process gets over. It is when claims if formed and send with any necessary authorization paperwork to ensure that the insurance company will pay for the claim that the healthcare providers deserve; this comes under the post-billing work. The post-billing steps further expand to rejection management, payment posting, accounts receivables Follow-up. These steps are when with the help of a stringent check for the reason of denial or rejection is invested properly once this is done payment posting followed by account receivable follow-up is initiated, where the team of experts people continuously follow-up about the whereabouts of the claims reimbursement status.
Common Problems in the DME billing process:
Unaware of the DME billing process guidelines and diagnosis coding: as DME billing is different from other medical billing specialties, it is often seen that most of the in-house staff handling the DME billing and coding process are not always aware of the billing coverage and preauthorization guidelines or in that case diagnosis codes too that leads to error in the DME billing process; which resulting in DME billing denial or rejection.
Incomplete documentation: DME billers due to the extensive process and juggling between administrative work and billing process often miss out on small documentation details landing in rejection or denial again.
Inefficient resources – a survey in 2018, stated that 47% of DME providers avoid hiring new employees for any kind of DME work. It is also seen that hiring a team of DME billers, coders is an expensive business so healthcare providers end up with limited DME billers and coders piling them with a lot of work. Therefore, this too much pressure and limited time creates a disorder in the DME billing process
Obsolete reporting and usage of backdated software and technology–lack of knowledge about DME billing software awareness also leads to the unsuccessful medical billing process.
Way out to all these DME billing problems:
As the rising demand and the high wage of DME billers and coders are too making the list of DME billing problems, today, more than 85% of healthcare practices are opting for outsourcing their DME billing process. A survey done on healthcare practices stated that healthcare practices think outsourcing is not only a convenient alternative but a cost-effective solution too.
How outsourcing your DME billing can help?
✓ Saves your valuable time and money – providing complete operational transparency, outsourced organizations with their team of expert billers and coders not only focus on seamless billing process but also reduces the extra software fee, training cost that healthcare practices have to spend in their in-house billers, etc. hence reducing the overall operational cost of the client. It also spares in-house billers from juggling between the demands of treating patients and handling billing issues which helps healthcare practice more focus on their core work of patient care.
✓ Reduces the chances of billing and coding errors– a team of expert billers and coders along with continuous stringent checks reduces the chances of errors in your DME billing process which in-house billers can.
✓ Helping with the highest Collection rate and productivity metrics – concentrating on the productivity and collection rate with an experience set of billers and certified coders, outsourced RCM organization here focus on attaining the highest collection rate along with faster reimbursement.
There are many RCM organizations with complete HIPAA compliance, and 99, 9% accuracy rate ensuring 70% operational cost reduction. Along with excellent industry references, it also reduces your AR bucket by 30% from the one month itself. With robust reporting, these RCM organizations also offer free telemedicine services to increase the volume of your patient intake.