Avoidable Errors during DME Billing Services - I-conic Solutions

Avoidable Errors during DME Billing Services

Durable Medical Equipment (DME) is usually reusable equipment used for long-term recovery. Nowadays, it is witnessing exceptional growth. It is popular amongst the senior population, hence rising in demand.

Due to this, there have been changes seen in DME billing. In addition, the area of the DME billing system is seen to be quite complex. Hence if any error occurs in the DME billing, a physician may suffer a huge loss.

Read on to prevent such errors.

Coding Errors for DME Billing

Medical coding plays a vital role when it concerns DME billing. This has been seen to be one of the major errors in the billing process. Each medical documentation resembles a different code; hence any errors in this area may result in showing the wrong service. Hence you shall trust such a sensitive process to an expert. 

You shall also keep in mind that you have to avoid upcoding and unbundling as these mistakes aren’t taken lightly. There support each of your coded items with proper medical documentation. Ensure that while you are doing the medical coding, you have stated the same facility from where the patient was discharged.

Due to such errors, most of the claims get rejected or denied.

Following are 5 major points you have to cross-check before you submit the claim:

  1. Misuse of HCPCS codes
  2. Inaccurate filling of application
  3. Misidentification of respiratory failure using the wrong code.
  4. Failure to identify and use the correct codes 
  5. Insufficient details in the documentation of components, devices, grafting materials, etc.

Therefore properly check the medical codes before claim submission to avoid denial and rejection.

Verifying Patient Data

When doing a DME billing, it is really important to verify the patient data. If you haven’t verified the eligibility of the patient or what plans they have currently, it will result in confusion and claim denials. You have to be aware of what is covered in their plan or if their plan is still active before you provide any service.

Ignorance of cross-checking and verifying patient data will cause you to delay getting a reimbursement, or the claim will be rejected straight away.

Use of Correct Modifiers

During the DME billing, always crosscheck if you have used the right modifier. If a wrong modifier is used, this will result to claim denial.

Supporting Claim with Medical Necessity

You have to support your DME billing documentation with medical necessities. If you fail to prove the requirement of such, then it is likely that your claim will be denied or rejected.

Insufficient Documentation

In the process of DME Billing following are the aspects in which insufficient information can lead to claim denials:

  • Services recorded,
  • Incomplete form,
  • The physician’s signature is missing,
  • The improper mentioning of dates
  • Services offered to exceed what is in the insurance company’s scope.

Improper or insufficient information in documentation has been seen as a major concern in DME billing. Due to this, several claims are getting denied or rejected. The process of documentation is something that should be strictly looked into and maintained to reduce denials.

How do reduce Errors in DME Billing?

You have to keep a critical eye on the above-mentioned processes involved in billing and have an expert for sensitive processes like medical coding.

The best way to reduce errors is by outsourcing the billing process. This will lessen your workload and error so that you can properly focus on your patient. In addition, trusting your medical billing process in the hands of experts will reduce your errors, denials and rejections by a noticeable ratio.

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