In the intricate realm of healthcare management, one challenge threatens all medical practices—denials. Be it for Durable Medical Equipment providers, cardiologists, urgent care, etc.; all struggle with the same problem. In fact, four years ago, the Medical Group Management Association (MGMA) conducted a recent poll that unveiled an alarming trend: 69% of healthcare leaders reported an increase in denials in 2021. While the reasons behind these denials are varied, there is no doubt that denial is inevitable. As denials make their presence felt for all specialties, starting from DME billing, cardiology billing, urgent care billing, etc, today, medical practices are tasked with a critical mission and concern that is -How to decipher and address the root causes behind these rejections, especially in case of DME as it has one of the highest denial rates as it requires strict compliance with documentation and coverage criteria, due to the directives from Medicare and Medicaid.
How do you fix your DME billing denials?
Denials are not just a concern; they have been and always will be a burgeoning issue in the healthcare landscape. While Nick Raup, the Associate Vice President of Product Management, Revenue Cycle Solutions at Change Healthcare, underscores the significance of addressing front-end issues. It is true that the report has shown that registration and eligibility, accounting for nearly 27% of denials, persist as a top concern. While 11.6% of denials stem from authorization/pre-certification issues and 10.6% attributed to services not covered. It is no secret that half of all denials result from front-end challenges. So now the question that most HME and DME providers might ask is to get the front-line defense right.
5 Strategies to Battle DME Denials
Precision in Patient Data: The journey to thwart denials begins at the very outset—with patient data. Ensure accuracy during pre-registration and registration to prevent downstream issues.
Claim Edits & Billing Software: Make sure that billing software like DME works, Brightree, TeamDME helps in editing DME claim, enabling streamlined DME billing processes and reducing the risk of denials.
Rejection Report Communication: Establish clear lines of communication for rejections received on reports. Swiftly implement corrections to minimize claim delays.
Addressing Internal Challenges: Internal obstacles often pave the way for denials. Tackle issues like resource scarcity, staff attrition, and denial backlog to prevent the influx of rejections; this is why today the cost effective way out is outsourcing.
Technology Triumph: Embrace technology optimization, automating clinical documentation processes, and investing in analytics and AI to stay on par with regulatory changes.
Outsourcing: The Path to Recovery
Denials undoubtedly come at a cost and today the average price to rework a claim is $ 25.20. However, the silver lining lies in the fact that a significant portion of denials can be avoided. In fact, a staggering 86% of denials are potentially preventable. Today, providers are looking for a cost-effective and efficient way out of the DME billing outsourcing option.
Today, when in-house resources turn out to be an expensive affair, outsourcing can be quite beneficial.
Taking care of your pre and post DME billing operation, starting from understanding where errors are slowing down to the root causes, an outsourcing expert does it all. While direct efforts toward registration/eligibility, authorization/pre-certification, medical necessity, medical coding accuracy, valid claim data, and services are initiated, outsourcing to the right DME billers and coders helps you as a DME provider to maintain a vigilant approach to patient insurance details. Staying ahead of all DME prior authorization regulations so you don't miss out and ensure your patient experiences better care.
As denials loom larger in the healthcare landscape, medical practices must rise to the challenge and find the right solution, such as SunKnowledge, to ensure a better DME billing practice and reduced denials. In short, by the right expert by your side you can understand the sources, focus on prevention, and execute strategic interventions; thus, by doing so, your practices can not only retain revenue but also fortify financial health.
