7 Most Common DME Billing Challenges

With the aging population and sleeping disorders such as sleep apnoea rising, the Durable Medical Equipment (DME) industry is experiencing a demand for equipment like never before. Now-a-days, pollution is also impacting many lives making them suffer from respiratory illnesses, demanding the equipment to support their breathing. In addition, lifestyle changes lead to more gastrointestinal dysfunction, hence the need for feeding tube equipment.

All these will eventually lead to more people looking for healthcare equipment at home to improve their quality of life. Not only the growth in the market for DMEs will rise further, but it is also making the DME billing process more complex than ever. The reimbursement is becoming a challenge, taking a heavy toll on the service providers.

While many DME services are already facing billing challenges, some anticipate it. But to mitigate the problem, one needs to be aware of the common DME billing challenges. Here are the seven most common challenges.

1. Coding Errors

There is a lack in the coding process in the Healthcare Common Procedure Coding System because it is not streamlined. This often results in healthcare providers failing to get reimbursement for the services rendered. Usually, the error involves using the correct modifiers, checking the payer and coding reports, and unclear narration causes repayment challenges in the DME billing and coding.

The top five DME coding errors are:

  • Incorrect usage of the HCPCS codes
  • In the trauma and fracture diagnosis, the failure to use the seventh character accurately
  • Misidentification of respiratory failure
  • Failure to note the proper components, devices, grafting materials, etc.

2. Faulty Document Management

Every DME business is required to manage and compile innumerable documents every day. It hence needs an efficient document management system in place, storing it and retrieval process for critical business information.

Unfortunately, the lack of proper software for digital document management often results in claim dismissals due to poor or incorrect documentation, business data loss, and, eventually, loss of revenue. It has also been observed that many DME services still use the legacy system for documentation. As a result, it results in more mistakes, but it makes the entire RCM system time-consuming and messy.

3. Regulatory Challenges

Like any other medical billing service, DME billings undergo frequent regulation changes. As a result, DME services often fail to stay on top of these latest changes and adhere to the new regulations and rules. This eventually affects the DME billing and reimbursement for the services. It is important to note that DMEs have a more complex and rigorous regulatory system in place, which often leads the service providers to be in a difficult situation with Medicaid and Medicare Services.

4. Denials due to AR Management

One of the billing challenges that often cause the DME services to fail is the sloppy AR management. Often, the billing failure and the revenue drying up are because the facility fails to upgrade its AR management to the latest application and software. Since they depend on outdated versions, they fail to match the evolving dynamics of the healthcare market and the changes implemented by the CMS with the DME billing and coding regulations.

5. Failure to Adhere to Payer Guidelines

One of the significant challenges in billing that the DMEs faces are cross payers denying the claims because of:

  • Medicare, Medicaid, or private health insurance plans have not authorized the procedure or are not covered under the plan
  • Therapeutic services that are considered
  • Lack of strong reason in the HCPCS since they are assigned to DME supplies and gears of level 11 codes.
  • The level of reimbursement has exceeded

The failure of the physician to prescribe DMEs is an essential requirement of the clinical treatment to ensure the bills can be reimbursed. But that’s not all the DMEs need to check whether the patient’s plan covers the services and equipment.

6. Trailing Billings

Many times, DME providers face the billing on time challenge, thus restricting the cash flows. As a result, many try to use shortcuts to catch up with the shortfalls. But in the long run, it leads to more complexities instead of increasing the revenue. With denials piling up and the management failing to follow up, the burden of the collection rate increases aggressively. It leads to more problems such as how to prevent them. The lack of data for analytics without the proper management leads to further trailing in the billing and deteriorates handling of the denials.

7. Untrained Staff

Most DMEs are overburdened with work, and the failure to train and educate the staff on the new guidelines and the DME compliance policies that are in effect results in incorrect billing and coding. It eventually leads to claim denials. But since, the facility itself is overworked most of the time. There is no time to train and educate the revenue and claim management staffs, which worsens the situation when it comes to DME billing.

How to Overcome the DME Billing Challenges?

One of the best ways to overcome the DME billing challenges is outsourcing the DME billing services and RCM system. But it would be a grave mistake to outsource it to anyone. So instead, you need a partner who can provide an end-to-end DME billing solution while optimizing the RCM.

24/7 Medical Billing Services is one such third-party DME billing company that offers the best DME billing services with a team of experts efficient in management. A partner like us provides an integrated technology platform that helps you drive the business better with improved ROI.

The services offered by 24/7 Medical Billing Services in DME billing elevate the patient’s experience and optimize the cost of the facility with the proactive risk mitigation plans in place. Our DME billing experts are always on top of their game with the latest knowledge of the CMS rules and regulation changes and policies and practices that any DME services need to comply with to stay in business.

Read more: Common Errors With DME Billing Services

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