Description
DME has been a high-rate billing item for fraudsters for years. These claims are more closely reviewed by payers and CMS than most. Any DME Billing Service team that does not follow the documentation procedures strictly will not only have claims denied, but their bills could be audited for months in one swoop. Risk factors outweigh the cost of making a mistake when considering the risks associated with an audit.
The Documentation Package Every DME Claim Needs
For the claim to come true for every DME billing service, there must be three factors. A clear written prescription from the provider who prescribes the medication. A medical need certificate, which identifies the need for equipment. Clinical notes provide a reason for the diagnosis and why the equipment is necessary. The three must be at the same time and in harmony with one another. The absence of anyone is a risk to deny or audit the claim.
HCPCS Code Specificity
The HCPCS Level II codes are used by DME. These codes are very detailed. The code for a standard manual wheelchair is different from the code for the power wheelchair. The code on the machine for a fixed-pressure machine is not the same as that of an auto-titrating machine. If teams aren’t familiar with the distinctions, DME billing service teams will incur denials due to using inappropriate codes. There is no DME billing support for approx.
Modifiers and Rental Status Tracking
Modifiers for DME claims indicate if the equipment is rented or purchased and if it is a new claim or a continuation. If you submit DME billing services with improper modifiers or modifiers are absent, their payments are processed incorrectly. If a modifier is missing in a rental claim, the rentals will affect the reimbursement calculation for all claims in the rental cycle. One of the most basic tasks involved is knowing the status of each tracking with each patient and putting the right modifier on all of the time.
Why AR Management Medical Billing Determines More Than Most Practices Realize
So, it’s easy to submit a claim. Once the claim goes out, it is where practices make their money or lose it. AR Management Medical Billing is the process of catching up with each claim that has not been paid or has been underpaid until it is understood. Collectively, AR-practicing practices claim more than those that don’t practice AR.
Aging Reports Need Daily Attention
Each of the unpaid claims is closing in on a decision. Many payers have caps on the filing time for appeals/resubmissions. Once those windows close, the money’s gone, even if that’s a good claim. Medical billing of the AR management medical bills, which involves the monthly aging report review, is already lagging on the claims that were supposed to be paid weeks ago. Daily prioritization is crucial in AR management in terms of claim age and balance value, as well as payers’ deadlines.
Denial Patterns Reveal Systemic Problems
If the same denial reason is made for several of the claims, it’s not by chance. It has failed to process. And with AR management, medical billing that can monitor the reasons for denials by code and by payer, those patterns can be identified and rectified at the source. Once the root cause is corrected, it eliminates repeating the denial on the same subject. When dealing with denials, tackling them on an individual level without seeking the pattern simply keeps the problem going forever.
Patient Balances Are Part of AR Too
The number of patients with greater or higher deductibles has increased, with patients paying more than ever. The medical billing aspect of the AR management that merely addresses the part of claims from insurance only covers a broadening slice of the total receivables. Like insurance claims, patients deserve to have their balances maintained in a systematic fashion. Statements sent early, with consistent AR follow-up at 30 and 60 days, will bring in more AR from the patients than statements that are sent later with no follow-up.
