The Durable Medical Equipment (DME) industry regularly updates payor policies and is heavily inspected for accuracy. DME providers should implement and maintain a structured and organized billing environment to guarantee timely payments and streamlined revenue cycles.

Sometimes claim denials are unavoidable and need to be corrected to receive payment. When this occurs, the Accounts Receivables (AR) department needs to understand the timely filing limits so they can make corrections and resubmit the denied claim. If not, this can lead to loss of revenue and negatively impact the business.

Importance of Timely Filing

The most crucial reason for timely filing is the potential loss of revenue. If the denied claim or AR is not worked in a timely manner, you could lose revenue on that order. Then if the trend continues, your business could lose hundreds, maybe even thousands of dollars in revenue every month.

Another concern is its impact on future claims for purchase items or repairs affected by the denied items.

To reduce untimely filing, consider adding a procedure to review unpaid claims daily. Then, a dedicated person or the AR department can review claims payment, correct the issue, and resubmit it.

Common Reasons for Claim Denials

Here are a few of the most common reasons for claim denials.

Incorrect patient and insurance information
Incorrect coding
Missing documentation
Out of date payor policy guidelines
Typos or misspellings

5 Tips to Minimize Claim Denials

Here are some tips you can begin to implement to help you minimize your claim denials.

#1 Intake Checklist

Create an intake checklist to ensure all patient and insurance information is correct from the beginning.

#2 Dedicated Staff Member or Department for Industry Changes

Ensure a dedicated staff member or department can stay current on all industry guideline changes.

#3 Review Claim Denial Reasons

Have staff review claim denial rates and reasons to learn how to improve claims submission and from repeating mistakes.

#4 Analyze Your Claims Process

Review your claims and document processes from intake to submission for errors, gaps, or missing pieces.

#5 Regularly Look for Improvements

Implement quality control process for all documents
Ensure all billing coders are well trained
Train every staff member on your DME billing process as needed
A separate person should review all documents before a claim is submitted.

Medbill’s DME Billing Services

At Medbill, our 100% US-based team will provide you with quality, superior service and become a support system for your billing team to ensure timely claims and reduce your claim denial rates.