Effective Solutions to Blocked Revenue for DMEs

September 24, 2015

Effective Solutions to Blocked Revenue for DMEs

Durable Medical Equipment (DME) is any kind of equipment that offers therapeutic benefit to patients due to certain medical conditions. A complex industry with an ever changing environment, the DME industry is fast growing since last few years. However, the challenges faced by it are manifold. Constant changes and increased complexities of insurance and medical claims along with a move towards consumer driven payment models are directly impacting revenue flow and margins for DME.

The challenges keeping DMEs from getting the entire payment do not stop here. Following are few more-

  • Tight credit markets, increased regulations and the rise of competitive bidding which impact reimbursement rendering some business models for this industry obsolete. The revenue cycle of DMEs is faced with workforce issues, restricted productivity, and a slackening growth.
  • Greater risk sharing with accountable care organizations (ACOs) and pay-for-performance models focused on outcomes
  • Decreasing margins make service revenue dire as procurement authorities steadily reduce product margins
  • DME providers receive insufficient information from the physician; hence converting the codes accurately & billing gets difficult leading to delays in claims and a shortage in cash flow.

In light of the above challenges, DMEs must focus on the following points in order to mitigate the negative impacts and collecting the revenue that they ideally deserve:

  • Modify processes to accommodate new regulations or market mix
  • Consistent technology platforms and analytics bearing a potential of driving key business results
  • Business acumen to increase functioning
  • Aggressive cost optimization through process revamping streamline order-to-cash effectiveness
  • Outsourcing end-to-end revenue cycle management or a part of it to control costs and find out revenue leakage

The coming of ICD-10 has added to the existing challenges for DME. Although the DME you bill for will use the same HCPCS codes, the primary difference will be in the diagnosis coding itself. Thus it is imperative that DMEs bring about required changes in the work policies and their systems in order to collect maximum revenue and experience reduced denials.


Category : Revenue Cycle Management