Month: April 2017

  • DME Billing
    checklist-for-durable-medical-billing-suppliers-to-enhance-their-rcm-from-insurance-payments

    Checklist for Durable Medical Billing Suppliers to Enhance Their RCM from Insurance Payments

    It is a known fact that in the RCM process every process and workflow in the medical billing cycle has a correlation with the revenue cycle function. This is known to contribute to an industry average of 15–25 percent of overall operating costs ( a large population of DME/HME companies continues to operate at 25–35 percent revenue cycle costs). Added to this, is the increasing complexity of insurance benefits that DME billers have to deal with. And further adding to the woes are regulatory audits! Audits have led to increased scrutiny of processes, and appeals have grown more than 150 percent over the last three years as a result of high claim rejections. Moreover, due to the swing on pricing and sales strategies and other factors, DME Billing Suppliers work with slim margins, competitive bidding and often than not unfavorable contracts dictated by the payers. So what are the main points that DME Billing Suppliers need to look for if they intend to enhance their RCM, specifically from Insurance payments? Checklist: Below is a basic checklist to begin with and get you started in order to stabilize your RCM Documentation of the patient’s medical record: It is of utmost importance…

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  • DME Billing
    is-your-facility-providing-accurate-billing-transaction-for-dme-orders

    Is your Facility providing accurate billing transaction for DME orders?

    DME – Durable Medical Equipment is normally used for people with certain medical requirements and which could be for repeated use too. Moreover, DME can also be used at different times and could be just rented out for specific periods or for long term usage or for on a permanent basis. The complexities are many when it comes to billing for DME services, given the CPT codes and modifiers to be used and when. Added to this, some payers may or may not reimburse depending on their coverage or rules & regulations as each payer may have a different reimbursement component attached. Overbilling is one of the major issues that most medical providers of healthcare face when it comes to the DME billing process. This has led to the initiation of a number of audits by the OIG and can be a cumbersome affair. Checklist to determine accurate DME billing In order to determine if your facility has made provision for accurate billing transaction for DME orders, here is a checklist to work with. Modifier usage: Using appropriate modifiers and coding to the highest level of specificity requiring modifier use is very pertinent to accurate billing for proper reimbursements. Certified…

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  • DME Billing
    5-benefits-accrued-with-outsourced-dme-billing-service

    5 Benefits accrued with outsourced DME billing Service

    It is a well-known fact that DME billing can be nerve racking, given the changing regulations and rules not just by federal agencies but also payers. Moreover, the DME categorization and its usage given “medical necessity” and the pre-authorization and authorization requirements can be tedious and time consuming to incorporate when dealing with documentation. Hence, when you outsource the DME services there are 5 benefits you can be assured of: Trained staff: The trained staff takes care of all the billing details of the patient, not just their personal demographics but also name of the medical provider, the medical service rendered and the date of the patient’s visit. Ensuring that every detail is accurate and verified. The charge entry process: The most crucial component in the billing cycle which ensures your healthy revenue and where the claims process is most critical for your RCM process. This process ensures that insurance claims are processed accurately with all information like the fact sheet of the patient, physician details, details of insurance coverage of the patient and billing information. Documentation: Part of the above charge entry process. Stringent documentation ensures appropriate charges are assigned to the codes provided by the team of DME coders…

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  • DME Billing
    is-dme-billing-giving-you-nightmares

    Is DME billing giving you nightmares?

    Durable Medical Equipment, as the name implies is medical equipment that is necessary for patients over a period for supportive medical care.DME Billing is a complicated process that involves patient validation, getting prior authorizations for DMEs exceeding the allowed limit if rented or purchased, using correct forms for claims submission (electronic or paper), submit claims to the primary insurer if there is one, ensuring to submit the itemized bill with the claim form, usage of HIPAA compliant billing software, determining the proper billing codes (CPT, HCPCS, ICD-10 CM), resubmitting denied claims with the correct codes. All these can be very exhausting and prone to errors and delay in claim settlements and in some cases, recoupment of claims also happens. Moreover, increased regulatory changes & scrutiny, & the emergence of competitive bidding have impacted reimbursement. Physicians involved in providing DME services are facing the brunt which is affecting operations and profitability and the nightmare of how to deploy resources and where to invest. When a patient gets a prescription for a DME, the provider needs to verify the patients (beneficiary) eligibility and valid coverages under their benefits plan. Most of the cases the DME supplier or the beneficiary’s medical care provider…

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