Billing is the chief characteristic of any business. The same holds true for DMEs (Durable Medical Equipment); which denotes billing for the usage of medical equipment and supplies. DME includes wheelchairs, nebulizers, oxygen, traction equipment, walkers, kidney machines, crutches, ventilators etc. DME is covered in certain illnesses under selected preconditions such as – if it gives therapeutic advantage to the patient, is not just a comfort item, is recommended by a licensed provider, and if it does not have any noteworthy non-medical uses (e.g. air conditioners, humidifiers etc.).
Many physicians dispense DMEs from their practice while some send the patient with a prescription to a DME provider. The ones who allot from their practice create revenue as well engage in providing a significant service to patients by saving their time and energy of going to other facilities/providers. HCPCS codes (level II) are used for categorizing equipment and supplies. Public and private insurers use this scheme for DME billing and claiming purposes. Further, insurance providers put forth certain criteria for DME billing which consists of items that can be used repeatedly, should be suitable for home use and serve a medical purpose.
Outsourcing DME billing
While healthcare providers/DME business owners do have in-house departments for billing DME, outsourcing is considered a better option for several reasons. Outsourcing DME billing energizes growth in the healthcare sector. It increases efficiencies, streamlines processes, reduces fraud, controls costs and paces collections. Further, as this task is done by professionals, additional activities such as effective business strategies can be contemplated for expansion. Outsourcing will also allow the healthcare provider focus on the best amenities for patients rather than look over billing and its appalling features themselves.
Reasons for outsourcing being a beneficial initiative
Claim denials: There is a definite reduction in claim denials which usually occurs due to incorrect or incomplete documents. The outsourcing agency is conversant with the payer guidelines leading to a decrease in denials. They are also aware of the diverse and ever changing coding systems such as ICD-10 and HCPCS, which reduce the requirements for refilling or rebilling (A/Rs usually increase due to this factor). All these aspects decrease the turnaround time and enhance cash flow.
Staff: There is a cutback in the number of staff and their related benefits such as training and insurances, office space and payroll, vacation time, and the related expenses of employee turnover which is usually present for in-house employees. Moreover, costs of installing systems (hardware and software) also decrease.
Outsourcing staff: The outsourcing staff understands billing dynamics and is well trained in the most recent alterations in insurance regulations, documentation requirements and billing practices. They are also knowledgeable about the reimbursements procedures and guidelines of Medicare and Medicaid, along with dealing and negotiating their healthcare plans.
Appeals and reports: Outsourcing DME billing to experts enhances correct and complete reimbursement as they challenge erroneous payments or denials. Occasionally, customized reports are created as per individual requirements.
When an independent physician or a large healthcare provider is looking towards working with outsourcing agencies, it may take a while or a few costs to be escalated whilst adjusting the new outsourcing company to the healthcare providers’ environment and prerequisites. However, as pros outweigh the cons, outsourcing DME billing is usually considered viable and profitable as it resolves concerns rather than merely billing.