DME billing is not very straightforward, and when healthcare providers integrate it to increase their revenues, the complexities increase. Medicare is known to lose more money to wasteful spending than any other program government-wide, with more than $60 billion in erroneous billing each year
The most common errors with DME billing that can trip anyone involved in DME billing are listed below.
- Verification of Patient Data: More often than not, DME billing claims have been denied because of a small error either by the Insurance provider or the CMS because of the error in names or the way the forms have been filled in.
- Coding errors: When the provider submits medical documentation indicating a different code other than the one billed &/or service was provided by someone other than the billing provider, the billed service was unbundled, or a beneficiary was discharged at a place other than the one coded on the claim
- Usage of Modifiers: More often than not, wrongly used modifiers for DME billing can lead to claims being denied and/or rejected. Even a misaligned code can cause the claim to be denied
- Medical Necessity: when the documentation shows that the services billed were not medically necessary according to Medicare coverage and payment policies.
- Insufficient Documentation: When the medical documentation submitted is inadequate to support payment for the services billed. If the documentation cannot prove that the billed services were actually provided, or were provided at the level billed, or lacks a physician signature on an order, or a form required to be completed in its entirety or even if each date of service is not billed separately, or the service was billed for more units than those allowed within a specific time period for the member. Insufficient Documentation alone accounts for $2.6 billion of the total $3.2 billion in waste of the Medicare Trust Fund.
The last point, Insufficient Documentation, is one of the most critical lapses that most healthcare providers in the healthcare industry tend to make. Without proper documentation, coders and billers will find it difficult to put in the correct information, which in turn leads to claim denials. And when documentation cannot be provided to support the claim enough, healthcare providers not only lose the cash inflow, but also the time and effort invested in a major downer!
Knowledge about the constantly changing CMS rules and regulations is also vital for the DME billing team to keep abreast. Wrongly coded modifiers can cost your Revenue Cycle Management (RCM) process a tremendous hit which can bring down profits leading to even a loss of productivity.
Hence it is vital that especially when documenting, more attention should be paid and rechecked before it is streamlined to the coders and billers and processed for its claim. As one of the old Japanese sayings can teach us to be more diligent when documenting, “You trip against a stone not a mountain”, hence be vigilant and stringent when it comes to documentation alone.