Tips to solve the payment puzzle in DME billing

As a certified DME biller and coder there are a number of tasks that establish the reimbursement process and leads to the successful growth of revenue cycle management. Outsourcing your work priorities to experienced medical billing company will enable your healthcare business to accelerate the pace of income generation, lessen operational expenses and increase the efficiency delivered by the system.

Here are some efficient tips to solve the payment puzzle in DME billing

Conducting thorough insurance verification

Your accounts department first and foremost should accurately verify whether or not a patient is insured and covered for DME services. If he is covered they need to determine for what kind of DME services they are entitled. The insurance verification team need to ensure that no claim is submitted without cross checking this information. Similarly, cross-verification of spellings of patient names and checking whether they have the right information can be very helpful in keeping claim denials at bay.

Documentation is the key

• Always comprehend the proof of delivery rules you should be following
• Apply the right modifiers to confirm you have the proper documentation needed for reimbursement
• Be aware of the latest policy changes from major insurance providers on pre authorization requirements

Avoid documentation errors

If you miss to follow to even a single condition of payment such as absence of one doctor signature, your claim is at risk of falling into the inadequate documentation error category, which will extend your AR days or cause a denial.

Handy tips to avoid documentation errors

• As a way to get reimbursed, ensure that your in house staff, such as the nurse, medical assistant or the doctor himself clearly records and documents a face-to-face encounter examination with the patient in the 6 months prior to raising an order for certain DME equipment.
• Check if the ordering physician and DME supplier are enrolled in Medicare on the date of service to receive DME reimbursements.  
• Determine that the doctor’s National Provider Identifier is on the valid detailed written order.
• Keenly analyze and understand which HCPCS code related to DME require a valid detailed written order.

Checking patient’s medical necessity

To determine medical necessity, the supplier needs to submit a paper trait that greatly supports medical necessity for the Durable Medical Equipment.

This includes:

• Provider prescription and clinical documentation.  
• Patient’s medical record
• Patient’s clinical and functional status to determine medical necessity
• Overall benefits and outcomes from using the DME

All in all, taking a few steps to optimize your DME billing process can drastically improve your collection rate and upsurge the revenues. However, coming up with a game plan and practically implying it are two different things. If you still are caught in the DME payment puzzle, its time find an able DME medical billing and coding partner who can swim you through the tiresome documentation work and provide you a healthy bottom line at the end of each month.