3 most common dme billing challenges

INFO HUB SERVICES
3 Most Common DME Billing
Challenges
Email Us : inquiry@infohubservices.com Call Us: (888) 694-8634

Introduction
DME billing is complex, and Info Hub, a leading offshore DME billing company in India comes with
the required expertise to help increase your revenue.
Efficiency is the key to success in any healthcare setting! Your ability to innovate and improve
patient experience while lowering costs and minimizing mistakes is critical to your success.
To fulfil these objectives, it is critical to have a well-functioning medical billing system in place. With
our DME billing services, we leverage our experience, expertise, and latest technology to ensure
complete accuracy and competence.
2

Policy Violations
When invoicing or payment for services is not in accordance with the written policy, it is
considered a policy violation.
DME claims sent to Medicaid rather than Medicare or another primary insurance plan.
Medicaid is considered the payer of last resort, so payment should be sought from other
insurance first.
3

Coding Errors
Errors in code are another major cause. The claim will be refused if your billing
team submits medical documentation with different codes than the ones billed.
Typical coding related challenges are –
 Using HCPCS codes incorrectly to drive a diagnostic related group (DRG)
 For trauma and fracture diagnosis codes, the seventh character is
incorrectly applied
 Respiratory failure is misdiagnosed
 Using guidance tools incorrectly
 Inadequate documentation of devices, components, grafting materials, etc
4

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5

Insufficient Documentation
When a provider’s documentation does not fully support the billed procedure code, it
comes under the insufficient documentation error. Common DME claim documentation
errors include:
 Medical Necessity – It is critical that the evidence demonstrates the treatments billed
were medically necessary under Medicare’s coverage and payment policies.
 Use of Modifiers – Incorrectly employed modifiers for DME billing can result in claims
being denied or rejected. Even a misplaced code can result in a claim denial.
 Verification of Patient Data – A common factor is a lack of patient data verification.
Claims are denied by the CMS or the insurance provider if there are minor errors in
names, or the way forms are filled out.
6

Ways to Reduce DME Billing
Errors
Quality control on services
 Verify the equipment or supplies provided are in accordance with
documented policy.
 Verify the delivery of equipment or supplies is in line with
beneficiary or representative signature.
 Verify that the completion of environmental modification is
completed with beneficiary or representative signature
7

Quality control on beneficiary records
 Confirm if beneficiary has other insurance as a major payer
 Determine a beneficiary identifier on each document.
 Double-check the documentation accurately so it reflects the type of DME and quantity
delivered.
 Check the quantity of units billed as part of the claims processing quality control.
 Confirm the procedure or service code is correct, along with the service dates entered
on the documentation.
 Ensure the claim’s number of units and product description match the documentation’s
number of units and product description.
8

Conclusion
Offshore DME billing services have the required resources at disposal and are responsible
for a knock in profits if they use incorrectly coded modifiers.
Given the difficulties and complexities of DME billing, many providers opt for offshore DME
billing companies.
By offshoring their billing, they gain access to a team of highly trained coders and billers that
are dedicated to delivering timely payments, minimized errors and increased collections.
9

About us
Info Hub Services was founded in 2010, and is now one of the leading service providers of highly
motivated, certified coders, and billers in the US medical billing industry.
Contact Us
India Address:
Info Hub,
Sf No 558/2, Udayampalyam Rd, Nava India,
Coimbatore, Tamil Nadu 641028
US Address:
Info Hub,
1280, Patterson Ter,
Lake Mary.
Florida 32747

3 most common dme billing challenges

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