Did you know that DME accounts for 2% of Medicare’s yearly payout? According to the Centers for Medicaid and Medicare Services (CMS) National Health Expenditures 2021 Highlights, they also saw an increase in DME spending! In 2021 there was a 21.8% increase, which brought the total to $67.1 billion for the year.
As those numbers continue to climb, your possibility of increasing sales and revenue grows. Unfortunately, as your team submits more claims, you could see an increase in claim denials. That’s where denial management solutions can help. When your billing team has a strategic denial management process in place that allows them to find errors that cause denials, you’ll be geared up for success.
We’re here to help provide you with some proactive tips on DME denial management in healthcare processes to assist your billing team in reducing your overall denied claims.
Does Your Billing Team Follow a Strict Claims Submission Process?
You might be surprised to learn that many claim denials result from minor errors.
- Incorrect patient information
- Wrong HCPCS code
- Missing documents
And you can avoid many of those mistakes if your team follows a thorough intake process. However, claim denials can occur even within the most rigid submission processes. That’s why denial management in healthcare for DME providers is an essential element for success.
The Importance of DME Denial Management in Healthcare
It Can Save You Money
When you need to resubmit denied claims, it reduces business profits since someone is reworking the claim several times. A well-organized DME denial management process allows your team to work more efficiently, saving your business money.
Maintain Your RCM Process
Claim denials disrupt the cash flow process, which impacts the Revenue Cycle Management. Strengthening the follow-up procedures can ensure timely reimbursements.
Improves the Claims Submission Process
As your team learns the reasons for the claim denials, they’ll share that information with other team members to correct potential errors before submitting a claim.
5 Tips on Refining Your DME Denial Management Process
As your team reviews and corrects denied claims, make sure they’re also taking the below steps to reduce the overall denial rate and improve the billing team’s claim approvals.
#1 Verify Patient Information Again and Again
It only takes a few extra moments to reconfirm patient data and insurance details. Many patients may not mention a change, and that one detail can cause denials to pile up.
Have your team:
- Verify patient details
- Confirm insurance information
- If setting up a new patient, make sure to type slowly and accurately
#2 Double Check Documentation Requirements
Every insurer has its own document requirements, so stay up to date on all industry changes to ensure your team submits the appropriate documents to show medical necessity, past test results, and physician’s notes.
#3 File Claims Daily
Don’t allow claims to sit around before they’re submitted. Instead, post them the same day or the next day. Missing a due date will result in an immediate denial even if all the claim information is accurate.
#4 Constantly Review and Update Workflow Process
It’s common for industry rules and regulations to change frequently, so your internal processes need to be updated every time there is a change to reduce the likelihood of denial.
Here are some tips to keep your processes current.
- Audit workflows and processes quarterly
- When a new change is announced, immediately update all internal processes
- Pay attention to claim denial reasons – if the denial reason often occurs, make sure the team takes note to check for that error before submitting the claim
#5 Evaluate Your Current Platforms
What was once helpful can become outdated. Review your current billing programs and tools to see if an update can help your team perform better.
Setting Yourself Up for Claim Success
Use the above information to help your team’s claim approval rate, but if you’re dealing with overworked or understaffed issues, Medbill can assist you. As a full-service DME billing company, we can work alongside your current team to help with your billing concerns.