As per industry research, thousands of dollars are lost in mishandling and unpaid claims in numerous fields of healthcare, including Durable Medical Equipment (DME). Added to this is the multifaceted billing and coding procedures, and the claim requirements of Medicare, Medicaid, and other private insurance companies. To ensure accurate reimbursements and timely revenues, it is imperative to hire an outsourcing agency as it works as a smart solution and completes all the billing and coding requirements; and assists in organizing the entire processes at a fraction of the in-house operating costs. It also makes the in-house billing and coding department’s work a lot easier, less time consuming, and lesser issues related to legalities.
Equipment which provides therapeutic benefits to patients who are in need due to certain medical ailments is categorized as DME. It is also known as Home Medical Equipment (HME) and is able to withstand repeated use. Equipment considered as DMEs is prosthetic devices, wheelchairs, oxygen equipment, insulin pumps, walkers, hospital beds, power mobility devices, etc. It is known that around 80% of the bills contain errors of some sort of the other, either incorrect details or the inability to follow the latest rules and regulations. It also gets difficult for a hospital administration to reduce errors, verify demographics and insurance on a regular basis, follow up on claims and payments, hence the need to outsource billing and coding services becomes essential.
Benefits of outsourcing:
- The team at outsourcing agency follows up on incomplete prescriptions (if any) from the medical practitioner as the first step and completes all billing documentation appropriately.
- The agency files claim with accurate coding and keeping other regulations in mind; and then forwards them to the concerned insurance provider, after verifying demographics and other insurance information (primary and optional verification of insurance policies). The agency also ensures 100% HIPAA consistency.
- The outsourcing agency takes care of denials and resubmits them on time while following up on erroneous payments. It ensures that maximum is recovered from Medicare, Medicaid, and other insurance agencies.
- The outsourcing agency can also create customized reports and posts timely and accurate Accounts Receivables.
- The outsourcing agency works with DME management software which takes care of billing and coding expertise. Having software and hardware in-house adds to high costs and maintenance. In addition, the outsourcing agency takes care of pre and on-going authorization procedures and supply chain management.
- In-house staff tends to cost a lot more than hiring an agency. In-house staff requires regular training, salary, and other benefits.
- The outsourcing agency has medical representatives to speak with, handle questions and complaints with the hospital staff at all times in case of need.
- The outsourcing agency submits claims within two days of the DME received by the patient and follows up in case of rejections within one day.
- The team at the billing and coding agency are always aware and updated (trained regularly) with the latest rules, regulations with respect to billing and coding guidelines for DME leading to great operational efficiencies, predictable cash flow, and increased productivity leading to an amplified bottom line.
Healthcare is undergoing vast changes. The need is to improve the quality of services provided to patients while gaining appropriate reimbursements as per the services provided by the healthcare provider/clinics/healthcare facilities. To avoid missed, erroneous or deferred payments it is essential for healthcare providers to ensure an efficient revenue cycle management process. This can be readily enhanced by hiring a billing and coding agency which can take a practical and streamlined approach to ensure a prior preauthorization process followed by a regular follow up with insurance agencies for gaining apt reimbursements.