The most significant process in the DME practice, besides the clinical services offered, is the billing and Revenue Cycle Management process as they bring in cash flows. The major changes both in the healthcare industry and the political scenario, are keeping people guessing and on their toes as to what changes are likely to come in and how this could further affect their practice.
Many DME practices, when it comes to billing and the revenue cycle management process, are unsure if they need to upgrade systems and manage training in-house or whether to outsource part or the whole. However, a thorough assessment of the practice needs to be done that includes:
- the infrastructure costs in terms of system and software upgrades,
- the capital investment required for regular staff training to upgrade their knowledge on the coding and billing practices,
- the verification and eligibility for DME services and regulations of different payers,
adding on new staff to handle the RCM process more efficiently for claim follows and chasing rejections and denials, - Documentation: It is also well known that the DME providers are often at the mercy of physicians as they receive meager information with respect to converting the codes accurately. Moreover, having specialized knowledge about reimbursement of DME incidents wherein accurate identification of the treatment episode where the use of the device eligible for reimbursement is required is often neglected causing high rates of denial
On the other hand, there are benefits for both in-house as well as outsourcing DME Billing Services
In-House |
Outsourcing |
| Retain control over the process and staff | Follow up on verification & eligibility of patient and payer information, thus saving time and costs |
| If the infrastructure is already in place- then best to just analyze, downsize and realign workflows and processes for better ROIs | Low investment required for a regular upgrade in hardware and software to readjust to CMS and other regulatory demands |
| If knowledge with respect to the complex labyrinth of billing & coding and insurance claims processing is in place then keeping them in-house can be profitable | Staffing problems and issues decline to keep the workflows and processes running smoothly. No absenteeism as there is someone to replace another person handling any pain points |
| Gives you the personal pulse of what is happening, if your practice is small and staff reliable and diligent | HIPAA compliance consistency at every new ruling |
| If using analytical reporting tools in-house, then helps make more informed decisions based on how the practice is doing and help organize it more effectively | The electronic Claim submission process is already in place and works efficiently. Moreover, the need for a third party to perform and bring down claim denials is beneficial to both, bringing win-win profitable earnings to both parties |
The above table gives a fair assessment of the benefits of either choosing to retain the in-house team or outsource your DME billing services. Depending on the size of your practice, and conducting a thorough assessment of your practice’s cost, staffing, and the volume in light of the present changes in the healthcare industry rules and regulations and the changing political scenario, you will need to determine what’s right for you!