Getting to know the basics of denial management is vital for successfully running a medical practice and Durable medical equipment (DME) facility. Facilities that are showing positive bottom line numbers at the end of each month will generally have denial rates below 2%-3%. Also, nowadays payers are embarking system software’s so they can identify different payment procedures which apply the contract requirements. For some insurer’s, it seems that the procedure is skewed to effect denial, whenever anything is unclear. Along with this, most insurance companies expect only a fraction of DME facilities to follow-up on the claim and re-submit a corrected version. Clearly, producing clean claims saves facilities money.
Indeed, even with the rising number of claims being denied all the time, DME facilities must not lose heart. There are numerous ways to answer the issue of, how to rectify increasing claim denial rates. Practices can obviously target regular zones of through where a claim denial occurs, but looking beyond the traditional norms is not just enough. Today, even a minute DME billing and coding mistake can lead to a denial or delayed reimbursement. And in such a scenario, if you are not applying the right kind follow up procedures, the chances of you getting paid are scarce.
The first thing ‘you’ as a DME supplier should comprehend is as to why the claims are being denied?
For DME billing service, there’s nothing more disappointing than a denied claim. Most of the times you get to hear that the work was done but a minute coding error lets the claim to be denied, which is pretty frustrating.
When this happens, DME suppliers need to resubmit their claims with the expectation that they corrected the issue and would now be able to get the money they are owed. Another point to remember here is that even though the facilities enhance their denial and collection rate, the amount of time they took to work over it, can never be reimbursed. In all cost-saving avenues, it will cost you $25 to $30 to manage with the overall denial and follow up procedures. The best thing one can do here is to appoint a durable medical equipment billing companies to handle all the charges and denial management procedures, so you can concentrate on the business side of the work.
Cleaner Claims is the name of the game
Dissecting each claim manually is an overwhelming task. Filtering through a large number of codes and recognizing what is being denied and by which payer will never ever let you get a grip on proper denial management process.
The goal for every facility and medical biller is to get their claim paid on the first pass. With how far billing software has advanced can be kept under control as practices can implement web-based denial management procedures that are quick and cost-effectively to see improvement in first pass resolution rate almost immediately.
Ideally, a Denial Management System Should Include:
Charge Entry Scrutiny: –
Check claims in real time to confirm diagnosis and procedure codes as you ensure compliance before submittal.
Set Advanced Rules Engine: –
Track payer denial activity and identify new regulations. New and developed medical billing software can anonymously track these rules over the user base and automatically distribute new rules over the entire network for complete claims qualifications.
Claim Notifications: – Automatic claim alerts for events like claim resubmissions and claim status to improve payment transparency can guarantee reimbursement until the last cent.
Power of Analytics: –
Customizable real-time reporting to make sure claims are being paid in full and spot areas where improvements can be made.
Flexibility in denial management approach: –
The ability to integrate with other software systems and be easily upgraded for changes in rules and coding is also an effective denial management system.