Laying the Foundation for a Successful DME Business Model

You’ll need to lay a solid foundation to operate a sustainable and profitable DME business. Part of a business foundation is developing a DME business model that’ll define your company’s plan for success. It involves several components, including the type of products to sell, your target customer base, and expected business costs.

A DME business model differs from traditional medical business models. This article will educate you on what to consider when operating a DME business. 

How to Develop a Sustainable & Profitable DME Business Model

With a promising future for the DME industry on the horizon, this is an opportune time for DME providers. But before you move too fast, you’ll want to lay the groundwork for a profitable business. As you review and determine your plans, consider these four areas and how you can prepare your company for success. 

AR Management 

Knowing where your money comes from allows you to make confident business decisions. And the accounts receivable (AR) department can help ensure your company’s financial stability. 

Make sure the department: 

  • Actively follows up on denied insurance claims and past due patient invoices until payment is received 
  • Regularly checks up on all open invoices 
  • Follows the necessary process for a claim’s denial 

Properly Train Staff 

Your employees are a vital component of your success. While every department needs its own set of skills, keep in mind these points during interviews and training of current staff. 

  • Properly handling medical equipment 
  • Practical communication skills to interact with patients 
  • Organized and detailed to ensure that all documents are received and filed correctly
  • Well-versed in compliance requirements for accreditation 

The last skill is essential for the billing team since they submit claims for payment. Claims that lack the correct documentation or contain inaccurate information will result in a denial and delay your payment. 

Audit Readiness 

As a DME provider, you could be subject to an audit at any point. There are several different types of audits, including: 

  • Comprehensive Error Rate Testing Audit (CERT) 
  • Medicare Administrative Contractors Audit (MACs)
  • Recovery Audit Contractor (RAC)  
  • Unified Program Integrity Contractors Audit (UPIC) 

The purpose of these audits will vary. For example, some will ensure that past claims were paid accurately. In contrast, other audits search for fraud and abuse in Medicare and Medicaid and attempt to stop it from occurring. 

DME Regulation Changes  

It’s common for the industry to modify payor policies, reimbursement regulations, and compliance guidelines. The Centers for Medicare and Medicaid Services (CMS) is the agency who’s responsible for making these changes for DME providers. As a result, you’ll need to monitor industry news to avoid costly mistakes, penalties, and payment delays. 

The Next Steps of Success 

As you move forward to developing or adjusting your DME business model foundation, keep in mind that sometimes you might need additional assistance. Outsourcing companies can help you with your needs, including billing services. Learn more about the benefits of outsourcing DME billing.

Advance Your Business Forward with Medbill 

Consistency is a significant component of a sustainable and profitable business. As a top DME billing company, our team of experts can help you implement consistent processes to streamline your operations to ensure claims are accurate and paid on time. 

We’re here to help you succeed – contact us to learn more.