One of the most scrutinized billing areas by Medicare and other commercial carriers is the Durable Medical Equipment (DME) billing. One of the primary reasons it is often under investigation is that DME billing Services appear to be anything but straightforward. Furthermore, the complexities manifolds when healthcare providers and facilities integrate the DME billing into their service to increase revenues.
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Common Errors with DME Billing ServicesPDf.pdf
1. One of the most scrutinized billing areas by Medicare and other commercial carriers is
the Durable Medical Equipment (DME) billing. One of the primary reasons it is often
under investigation is that DME billing Services appear to be anything but
straightforward.
Furthermore, the complexities manifolds when healthcare providers and facilities
integrate the DME billing into their service to increase revenues.
Medicare has been known to lose more than $60 billion through faulty billing each year,
and part of the waste is due to spending on the DME billing.
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2. In most cases, DME claims are denied due to wrong information or small
error provided by the CMS or the insurance provider. For example, a slight
change in the name that might look insignificant or the way a form has been
filled up is deemed wrong by the payer will lead to claim rejection or denial.
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1. Patient Verification
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2. Errors with Codes
If a document indicates a different code than that of the billed or serviced, the
insurer will reject reimbursement. Also, a claim will be rejected or denied if the
service is offered by someone else other than the billing provider. There can be
coding errors in medical billing services shown as unbundled will get the
claim denied. Also, even if the beneficiary has been discharged to another place
after the procedure is considered as error. At the same time, the one in the
coded claim is different.
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3. Wrong Use of Modifiers
Often in DME billing, wrong modifiers or a misaligned code can reject the
claim or get denied. Hence, it is vital that when written codes are used for the
service, correct modifiers are mentioned to get the reimbursement for the
service rendered.
4. Necessity of the Medical Assistance
Once a medical assistance is done in DME service, the documentation needs to prove
that the billed service was necessary for the patient. If the Medicare coverage and the
insurance providers feel that medical assistance is unnecessary, the claim will be
denied or rejected.
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5. Insufficient or Incomplete Documentation
If the medical billing documentation provided has inadequate or
insufficient support for the service provided, the payment will be rejected. The
onus is on the service providers to prove that the billed services were provided
and at par with the level billed. Any missed information like a signature of the
physician on the order or an incomplete form that does not have the date or if
each date of service it’s not built separately, then the claim will also be denied.
Furthermore, before providing the service, the facility needs to check the
number of units that service can be delivered within a specific time to the
member. If the number of services exceeds the number allowed by the
insurance policy, the claim will be rejected.
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It has been estimated in medical billing and coding services, out of the $3.2 billion
that goes to waste in the Medicare Trust Fund, $2.6 billion is due to insufficient
documentation. It is essential that proper documentation with adequate medical
coding and correct information is provided so that it does not lead to claims denial.
One of the best ways to ensure none of this happens is by outsourcing DME billing
services to an efficient medical billing company such as 24/7 Medical Billing
Services.
A team of specialized medical billers and coders ensures that all documentation,
codes, and modifiers are correct for the claims. Also, they ensure claims are submitted
within the time frame. Additionally, in case of any denials, it is appropriately followed
up. Moreover, with the constant changing in the CMS rules and regulations, DME
billing staff must have in-depth knowledge of the changes. While at a time, it is not
possible, an outsourced partner such as 24/7 Medical Billing Services will ensure that
all the DME billing is done as per the new laws and regulations.
Read More Blogs: Add Profits To Your Practice By Outsourcing Your Medical
Billing Services
How To Ensure There Are No Errors?
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• We are a medical billing company that offers ‘24/7 Medical Billing Services’ and
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