Medicare and several other commercial carriers continue to scrutinize Durable Medical Equipment billing. This has pushed the need to understand and follow DME documentation requirements. If your billers fail to do so, it will not only put your office at risk of an audit but also result in refunding an insurance carrier or CMS which means unnecessary loss of revenue.
Your practice is purchasing DME in hopes to receive a profit in return. Since durable medical equipment isn’t professional services, this poses challenges in obtaining payments.
Some common errors that result in DME claim denials are:
- Lack of patient data verification is a common reason. If there are small errors in names or the way forms have been filled, then claims get denied either by the CMS or the insurance provider.
- Another common reason is errors in coding. If your billing staff is submitting medial documentation indicating different codes other than the one billed, the claim will get denied.
- It is important that the documentation shows that services billed were medically necessary as per the policies of Medicare coverage and payment.
- As mentioned-above, lack of sufficient documentation is a huge reason behind DME claim denials. If there is no proper documentation, it becomes difficult for coders and billers to put in the right information. All this will lead to a negative impact on cash flow and also result in wastage of time and effort.
To ensure that DME claims from your offices are being submitted on time and with accuracy, it is necessary that you hire billers and coders who are abreast with the CMS rules and regulations. If they are using wrongly coded modifiers, they will have to face a hit on profits.
Correct documentation is extremely important for DME. Attention needs to be paid when documenting and data should be rechecked before it is streamlined to coders and billers. Documentation needs to prove that the billed services were actually provided. In case of an audit, if it is found that you don’t have proper documentation, your practice will have to give that money back and also face penalties.
Considering the challenges in DME billing and the complexities involved, many providers choose to hire a third party for billing. Outsourcing their billing needs gives them access to a team of skilled coders and billers who work dedicatedly to bring timely payments for their clients.