Denials and Rejections in DME/HME billing stops the cash-flows and delay in getting the payment and the entire Revenue Cycle Management process gets interrupting. In addition to the denials and rejections, the expanded critical regulatory observation is pushing all DME services to renovate their operations to smooth processes and increase profitability also.
But, analyze and identify the reason for the denials and rejections to fix them before releasing them to the Insurance will reduce the denials and rejections and increase the DSO time. Here is some vital checklist that helps to reduce the denials and rejections and for a smooth billing process.
Before delivering the equipment to the patient, the DME supplier needs to verify the patient's eligibility with the Insurance company and makes sure the policy covers DME services. Even checking the patient's demographic information matching with the Insurance records and correct them before sending the claims to Insurance.
DME provider should understand the Authorization from the Insurance (based on the Insurance guidelines) before delivering the equipment so that the claim will not get denied for Authorization.
DME provider needs to check the frequency for the supplies before delivering it to the customer. Medicare will not pay for the supplies if given within the frequency period. Also providing the allowed units is another checklist which a provider should follow.
Adding an incorrect modifier or missing any modifier denies the claim. It is essential to have a checklist to add the modifiers while billing the claim. Medical necessity should be verified to add appropriate Diagnosis and coding.
Proper documentation on record to help The medical need for the DME item recommended is significant not only for the order entry person and billers as well as later if the case is dismissed and/or during auditing, to legitimize the fact. For instance, a KX modifier should use if the Supplier is maintaining the proper documents for showing the patient has a medical necessity. It is incredibly imperative that the request is kept on record by the provider and made accessibly to the Insurance on demand. This request needs to have the accompanying: demonstrate the finding/explanation behind the equipment, the correct date, and the Supplier's a signature, the claim gets caught in the audit and recoups the payment if the Supplier fails to maintain this.
If a supplier follows all the above checklist, their revenue will get an increase, and they will get the payment in the first time billing itself.
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