How to Deal with Denials in DME Billing?

Rejections and denials of claims in DME billing greatly impact reimbursements and cash inflows of a DME billing company, and it hits directly the revenue cycle management process. With CMS bringing in close investigations on DME services, the relevant companies are to restructure their business concerns and activities. This helps them in streamlining their processes and improving their revenue as well. But the foremost thing to think of would be why such denials/rejections happen for most DME billing services.

DME Billing Services
DME Billing Services

This blog can guide you with certain points as a checklist to understand why denials happen in general and how to deal with it before it goes to rejection.

#1: Check eligibility criteria for patient and do proper verification

The staff responsible for sending the applications for claims of a DME billing company should primarily focus on whether the patient is insured or covered for DME services and what are the eligible DME services for them. This checking is crucial and sometimes, spellings of names, incorrectly checked information box, etc. can be the reasons for a claim denial.

#2: Coding and modifiers

An invalid or a missed modifier can lead to immediate rejection of claims. To avoid this, you should keep a standard chart that notifies on correct codes and modifiers to your medical coders and billers. Whenever there is an addition/update on the coders and modifiers ensure that it is immediately reflected on your chart and your employees are informed about it.

#3: Documentation

Documentation is the next crucial one, which could lead to denial of claims when it is not sufficient or incorrect. Proper documentation has to support the medical necessity of any DME product prescribed. This acts as a helping hand not only during claims but also in audits to prove the claim is correct.

Every order should contain an indication of diagnosis/reason for using the equipment/medication, correct date, and the DME provider’s signature. Missing out any one can lead to rejection of claims. Therefore medical billers and coders should be very careful with documentation.

#4: Process and workflow

Before your initiate claims, it is important that you check and know about your internal processes, workflows and functionalities. If you identify a problem persists in the process by itself, changing the way you work, can save your time and effort of applying claims and receiving rejection status on them.

You can work out a dedicated and unique strategic plan for streamlining your DME billing process by creating a checklist for the key points aforementioned. Sorting out this points one by one will always keep you one step ahead and support you with reducing rejections/denials in DME billing claims.

You are not too late to follow certain processes to make your DME billing and workflow process streamlined. See if the following points can help you achieve your goal of reduced denials of DME bill claims.

  • Revolutionizing and rebuilding your processes and organization structure can keep your staffs intact with the new rules and procedures.
  • Updating the existing technology and adopting new platforms help in keeping processes in one direction and make you realize the pain point as well.
  • Outsourcing your entire DME billing and claims process to an expert company can literally get the denials down and ensures smooth cash-inflows.


24/7 Medical Billing Services is a medical billing and coding company that works rigorously and vigorously to get your claim reimbursements on-time. The company is well-known for achieving the maximum number of claims without encountering any rejections/denials in claims processing. Contact 24/7 Medical Billing Services team if you face difficulty with reimbursements or have high volume of tasks to be completed.

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