DME (Durable Medical Equipment) is typically reusable equipment used for long-term recovery. It is currently experiencing exceptional growth. It is popular among the senior population, so demand is increasing. As a result, there have been changes in DME billing. Furthermore, the DME billing system is seen to be quite complex. Therefore, if an errors occurs in DME billing, a physician may suffer a significant financial loss.
When it comes to DME billing, medical coding is crucial. This has been identified as one of the most significant errors in the billing process. As each medical documentation resembles a different code, any errors in this area may result in the display of the incorrect service. Not only this, the following are the avoidable errors to double-check before submitting the claim:
● Upcoding Errors
Upcoding errors occur when patients are billed for more complex and expensive procedures than they received. These errors occur when a DME billing department executive enters treatment and diagnosis codes incorrectly.
● Incorrect Procedural Code
A simple slip of the finger can cause a major data entry problem and alter the procedural codes. This error typically occurs when DME related information from encounter forms and other supporting documents is incorrectly documented.
● Unbundling Errors
This entails dividing the DME diagnosis procedure into several smaller procedures. When there is a comprehensive code for the entire procedure, each of them is billed and coded separately. This is an unethical method of billing a patient and may result in an audit. As a result, it is critical that your medical coders are aware of this error.
● No Specific Code
Some ICD-9 codes require a fourth or fifth code to achieve the highest specificity. If this section is left blank, the claim will be rejected. If the coder is unsure about the highest level of specificity, he should consult the codebook or the internet to confirm his facts.
● Inadequate Data
This error occurs when the healthcare provider fails to provide the necessary information to the payers, resulting in claim denial. These errors can be caused by employee mistakes. It can also happen when DME doctors don’t provide accurate diagnosis information.
● Report Misinterpretation
DME coders typically do not code the actual medical procedure unless the description includes the equipment details. Otherwise, it may result in incorrect interpretation of reports and errors in the DME billing and coding process.
● Outdated References
The staff must be kept up to date on the latest changes in DME medical codes. The references used by coders must be updated on a regular basis as the DME coding system changes. Any outdated references must be immediately replaced with new ones, or else revenue will be lost.
● Duplicate Billing
This is a case of human error in which the same DME equipment is billed twice. This may necessitate re-submitting a claim rather than filing a follow-up claim. These claims are typically divided into two categories: suspect duplicate and exact duplicate.
DME medical coding errors can be extremely dangerous if they occur on a regular basis. It can cost DME healthcare providers, clinics, and other medical centres tens of thousands of dollars. Some of the most important tips for avoiding DME medical billing errors are listed below –
● Use a Robust System
Using DME billing systems capable of detecting common errors before claims are submitted can significantly reduce the number of errors.
● Have a Well-Trained Team
It is critical to hire highly skilled individuals who have been thoroughly trained to handle any requests. To avoid duplicate DME billing, the team must ensure that each claim submitted is unique and not repeated.
● Follow Unified Processes
Outsourcing the DME billing process is the most effective way to reduce errors. This reduces your workload and error, allowing you to focus on your patient. Furthermore, entrusting your DME billing process to experts will significantly reduce your errors, denials, and rejections.