The durable medical equipment industry has been going through a rough patch for the last couple of years. The ratio of job openings to unemployed persons shown a steep during the pandemic, and the post pandemic scenario is no better. Hiring and retaining new billing and coding staff, rising labor costs and maximizing revenue have become a major concern. With so much to keep track of DME billing and coding providers are feeling quite a pressure. 

In fact, with the booming industry of DME, providers are overburdened with administrative tasks; and there is a huge gap between the available workforce and skills required. 

To make your task easy, here are some bad practices which you should get rid of. We also have suggested strategies to fix them. 

Bad Practices in DME Billing 

  1. Lack of on-filed claims: When your claims are not filed timely, you gain the risks of denials. Instead of payments, you will be burdened with write-offs, which will ultimately lead to reduced revenue.
    How to fix this: 
    (a) Create as many electronic claims as possible. This way, you will have the proof that your claims are on file based on the clearing house’s response.
    (b) Where electronic claims are not an option, consider secure fax or email communication and follow-up AR.
    (c) Go through the production reports of your AR team. Analyze the data and identify the payer with the largest not on file claims. Start with one-payer at a time and work through the list.  
  1. Losing track of unpaid claims: This is an extremely common mistake. As your staff is already burdened with clinical responsibilities, tracking AR can be a hassle. If you lose track of AR and the denied claims, you’ll face a deterioration in your practice’s financial health.
    How to fix this:
    Digitalized the overall system and consider a dedicated team who understands the criticality of AR follow up.  
  1. Lack of structured outreach process: After an order intake, you need all the precise documentation for effective claim submission. For instance, you have an order and there is some official form you need signed. The absence of signature, the claims drop into queue and doesn’t get sorted. You will lose revenue in this scenario.
    How to fix this:
    Make sure you have a robust outreach structure to communicate with the patient and the doctor. Keep in contact and at the time of service explain the payment process to the patient. Furthermore, always notify them in obtaining qualifying billing documentation and engage them within the whole process. 
  1. Not having a feedback loop between the team: A not on file authorization remains at the top denial for six months in a row. If your front and back-end teams are not immediately aware of it, they lose track of claim denials. As a result, the service is unpaid, and you lose revenue.
    How to fix this:
    In case of denied claims, feed it back to your front-end team. Train and educate the employees to work towards a defined goal to avoid these issues. 

Consider DME Billing Outsourcing 

As the tedious process of DME billing can elevate your task burden and overhead costs, you can opt for an outsourced billing team. A team of professional billers and coders have the knowledge to work towards effective billing for DME. They understand the intricacies and are always updated about the regulations and guidelines modifications. Furthermore, you don’t have to invest time and money in training and educating your staff regarding the tidbits of the billing process. Ultimately, your outsourced partner will work as an operational hand and navigate your ROI in a positive direction.