According to the Medical Group Management Association (MGMA), although 90 percent of DME billing claims denial can be avoided if precautions are taken. However, it’s important to note that rejection claims in the DME billing industry result in a reduction of 3% of total net revenue for healthcare practices.
Furthermore, even with a large denial management team, 1 out of every 5 service requests generated by in-house billers is rejected or refused. This results in reworking costs of up to USD 25 per denied claim.
Leaving healthcare practices around the country to spend $262 billion a year on rejected claims from insurers. This causes major cash-flow issues and recovery costs.
However, according to the MGMA, 2/3rd of rejected claims can be recovered because more than 80% of rejection claims in the DME billing process can be avoided. Moreover, even 30% of denials in the DME billing process are the product of front-end inefficiencies.
What are the prime causes of denial claims?
In reality, the prime causes of denial claims are thought to be administrative, but clinical factors play a role as well. This is particularly true when in-house billers are balancing the demands of treating patients, while still dealing with billing issues. This is why organizational extensions are tasked with assisting healthcare practices so that they can concentrate on patient treatment and lowering the DME billing rejection rate.
Tips on how to reduce Denial claims in the DME billing process:
- Proper eligibility and authorization verification check
One of the most common reasons for claim denials is billing a non-covered or ineligible program. This is often overlooked by in-house billers during the eligibility and authorization verification process.
In reality, studies have shown that this ineligibility is the cause of nearly 75% of denial statements. Moreover, complicated laws connected with individual payers play an important role in the rejection claims process.
All of this can be avoided if all of the information and data are correctly compiled and checked by a team of specialist billers and coders, employed by outsourcing organizations. The problem with the in-house billers is that they miss out on such information due to the extreme work overload.
- Gather complete Information
A minor error in the DME billing process, such as an incorrect demographic data address, can lead to claim denials and a backlog of claims. Outsourced experienced billers and coders are preferred because they make sure to gather and keep a record of the complete details.
- Ensures proper coding
In the DME billing process, maintaining correct coding codes is critical not just for ensuring the service or the specifics of the drugs, but also for the claims process. Since a single coding error results in not only claim denial but also a lengthy reworks procedure.
Hence to conclude, DME billing claims can be reduced if precautions are taken. Healthcare providers need to realize that each phase of the DME billing process is completed correctly to maximize claim benefits.
However, outsourcing is the best choice today because it not only frees up managerial time, so that healthcare professionals can concentrate on patient care. Moreover, it's also an extremely economical approach that guarantees lower rejection claims rates. Thanks to rigorous checks and teams of expert billers and coders.