How can DME providers boost income in 2019?

Several measures are being taken by the US healthcare industry to reduce costs and this has hit DME providers really hard. While they are being reimbursed by Medicare Advantage plans at a lower rate than other plans, growing financial responsibilities are also adding to the pressure. Due to these challenges, DME providers across the US are finding it hard to collect more and maintain a steady cash flow.

Here are a few opportunities or ways in which DME providers can protect their bottom line for the coming months:

•       Denial management is one of the most effective ways in which they can keep their business running. Nearly 90% of denied claims are avoidable, so they should hire experienced billers to help them get paid on time. By having expert staff, they will be able to proactively address the reasons for denials.

•       By changing the denials workflow, providers can benefit tremendously. For instance, when denials occur, offices choose to rework on the ones with the highest value. Due to this, they leave smaller denials that can add up to thousands of dollars in missed revenue each year. So reworking needs to be handled in the right manner, facilitating faster resubmission and reimbursement.

•       Pricing transparency will have to be improved if DME providers want to survive in business. This is necessary because now patients are responsible for more of their healthcare costs and they expect transparency in services as well as devices. It is important to ensure that the patients know what they will pay towards the cost of the product and what they will owe. Doing this will not only help the providers know the information needed to ask for full payment at checkout but also help drive collections? It will also help in improving patient experience.

•       To accelerate reimbursement, DME providers should also make payment easier for patients. This is important because patient payment comprises of a great portion of any healthcare organization’s revenue. So if there are any obstacles that can impede a patient’s ability to pay, then they should be removed. Since most of the DME equipment that patients either buy or rent is expensive, it is important that they have enough options to make payments.

There is no doubt that reduced payer reimbursement and higher patient-financial responsibility is here to stay. So DME providers need to be prepared to offset the impact on their revenue cycle.

About 247 DME Billing Services:

We are a DME billing company that offers ‘24/7 DME Billing Services’ and support physicians, hospitals, DME institutions and group practices with our end to end DME billing solutions. We help you earn more revenue with our quick and affordable services. Our customized Revenue Cycle Management (RCM) solutions allow physicians to attract additional revenue and reduce administrative burden or losses.

Contact: 
247 DME Billing Services
Tel: +1 888-502-0537
Email: info@247DMEbillingservices.com

Tips to Streamline your DME Billing Process

Proposed Rule by CMS

In 2019, CMS released the proposed rule that included potential changes to the DME payment rates. This long-awaited proposed rule is being considered positive because it includes vital improvements for payment in non-bid areas along with improvements to the CBP (Competitive Bidding Program).

The DMEPOS fee schedule has been updated by the CMS and several new codes have been added to the HCPCS file. For instance, DMEPOS fee schedule file includes fees for three home infusion G-codes - G0068, G0069 and G-0070. For other new CY2019 codes, the fee schedule amounts will be established under DMEPOS fee schedule update.

Fees have also been added for new HCPCS code (E0467). Fee schedule amounts are also being adjusted for shoe medication codes and mail order DTS. For CY2019, update factor of 2.3% has been applied to few DMEPOS fee schedule amounts. CMS is also implementing monthly fee schedule payment amounts for stationary oxygen equipment.

It has been published by the CMS in order to drive innovation in DME and also to modernize it. Here are some of the highlights of this proposed rule:

•      Starting and until CBP contracts are awarded, it has been proposed that the beneficiaries will be receiving DME items from any Medicare enrolled DME supplier.

•      For DME furnished, CMS has proposed traditional fee schedule amounts.

•      For non-CBAs that are non-contiguous or rural areas, items furnished will be paid at 50/50 rates and for non-CBAs; items furnished will be paid at current payment rates.

•      CMS has proposed new payment classes for portable oxygen and oxygen equipment, new payment rules for ventilators and has improved payment rates for new DMEPOS items.

DME coders will have to be prepared for coding changes coming their way. For DME providers, the only way to survive 2020 will be through hiring experienced coders or by letting an reliable third party handle the challenges of DME billing. 

About 247 Medical Billing Services:

We are a medical billing company that offers ‘24/7 Medical Billing Services’ and support physicians, hospitals, medical institutions and group practices with our end to end medical billing solutions. We help you earn more revenue with our quick and affordable services. Our customized Revenue Cycle Management (RCM) solutions allow physicians to attract additional revenue and reduce administrative burden or losses.

Contact: 
247 Medical Billing Services
Tel: +1 888-502-0537
Email: info@247medicalbillingservices.com

Hire Expert Billers and Coders who are aware of the ICD-10 Coding Changes

247MBS has been into the DME billing and coding domain for twelve years. Our company takes pride in its team of highly experienced DME billing experts who understand DME billing needs and cater to all the DME billing requirements of our clients.

In order to receive timely payments, it has become imperative for DME suppliers to demonstrate medical necessity of the durable medical equipment. Without securing and retaining the right documentation of medical necessity, obtaining Medicare payments can become a nightmare for those involved in furnishing DME and submitting claims.  

All this has pushed the need to have expert billers and coders who are aware of the Medicare regulations and ICD-10 coding changes.

DME Code Changes

Here are some of the April changes to the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) items and services.

·         Centers for Medicare and Medicaid Services (CMS) has not only added a diabetes code but also changed oxygen coding for the DME fee schedule by altering the HCPSC Level II modifiers.

·         Diabetic DME codes- there have been some changes that will affect coding of HCPCS Level II code K0903. According to the CMS, the fees for K0903 are set on the basis of fees for code A5513.

·         CMS released the DMEPOS fee schedule for 2019 that will be effective for Medicare claims that have a service date on or after 1st of January. Also, according to the AOPA (American Orthotic and Prosthetic Association), in 2019, the  Medicare Fee Schedule for O&P services will also increase by 2.3% compared to the rates in 2018.

Surge in demand for trained coders

Coders need to pay close attention to the details of doctor’s procedures and diagnoses. They will have to use very specific ICD-10 and CPT codes to get reimbursed. For instance, if they are using billing diagnosis code F11.20 on a claim with procedure code 80307, it will reimburse them about $30 less than specifying the exact upload being used by the patient.

To get paid on time, many suppliers have started outsourcing their billing needs to a third party. Outsourcing is giving them the opportunity to get reimbursed on time, without having to go through the hassles of keeping up with coding and regulatory changes.

About 247 Medical Billing Services:

We are a medical billing company that offers ‘24/7 Medical Billing Services’ and support physicians, hospitals, medical institutions and group practices with our end to end medical billing solutions. We help you earn more revenue with our quick and affordable services. Our customized Revenue Cycle Management (RCM) solutions allow physicians to attract additional revenue and reduce administrative burden or losses.

Contact: 
247 Medical Billing Services
Tel: +1 888-502-0537
Email: info@247medicalbillingservices.com

Do you want to Grow DME Business and Get Paid on Time?

To ensure success in the durable medical equipment business, it is important to ensure that your billing needs are being handled by experts.

Since the billing and coding rules for DME keep changing, it is very important to have coders and billers who are abreast with the industry changes. From submitting claims on time to adhering to the claims adjudication process, there is a lot that needs to be done in order to keep your business growing.

If handling DME billing and coding is become a stressful task in-house, it is recommended to choose a reliable billing service provider who can help you get paid on time. The billing company will offer you assistance in managing your revenue cycle with the best end-to-end solutions.

Since collections can be a daunting task for DME suppliers, having an expert team really helps. The billing company will work on pending accounts that need a strong strategy for payment collection. Because the team at reliable billing companies have an extensive understanding of the payer processes, it helps to get the job done in time.

Another benefit of hiring a third party for DME billing is the access to best of technology used for reducing TAT along with the best account management methods. An experienced team will be aware of the aging accounts and priorities them to get payments.

Partnering with a good DME billing service provider will give you access to expert staff who are experienced in this industry. Since a dedicated team will be handling the revenue cycle, you will be able to enjoy a big leg up on competition, without having to worry about payment denials or delays.

Besides improving billing efficiency, the team will also provide you detailed reporting related to your revenue cycle, keeping you informed about the financial strength of your business.

Only with the help of experienced and well-trained coders and billers, you can get rid of aging A/R accounts and reduce denials.

Not just DME providers but many insurance companies also use RCM companies for their adjudication and credentialing needs. It helps them reduce costs and ensure business profitability.

About 247 Medical Billing Services:

We are a medical billing company that offers ‘24/7 Medical Billing Services’ and support physicians, hospitals, medical institutions and group practices with our end to end medical billing solutions. We help you earn more revenue with our quick and affordable services. Our customized Revenue Cycle Management (RCM) solutions allow doctors to attract additional revenue and reduce administrative burden or losses.

Contact: 
247 Medical Billing Services
Tel: +1 888-502-0537
Email: info@247medicalbillingservices.com

Common Errors that Result in DME Claim Denials

To ensure that DME claims from your offices are being submitted on time and with accuracy, it is necessary that you hire billers and coders who are abreast with the CMS rules and regulations. If they are using wrongly coded modifiers, they will have to face a hit on profits.

Medicare and several other commercial carriers continue to scrutinize Durable Medical Equipment billing. This has pushed the need to understand and follow DME documentation requirements. If your billers fail to do so, it will not only put your office at risk of an audit but also result in refunding an insurance carrier or CMS which means unnecessary loss of revenue.

Some common errors that result in DME claim denials are:

•      Lack of patient data verification is a common reason. If there are small errors in names or the way forms have been filled, then claims get denied either by the CMS or the insurance provider.

•      Another common reason is errors in coding. If your billing staff is submitting medial documentation indicating different codes other than the one billed, the claim will get denied.  

•      It is important that the documentation shows that services billed were medically necessary as per the policies of Medicare coverage and payment.

•      As mentioned-above, lack of sufficient documentation is a huge reason behind DME claim denials. If there is no proper documentation, it becomes difficult for coders and billers to put in the right information. All this will lead to a negative impact on cash flow and also result in wastage of time and effort.

Your practice is purchasing DME in hopes to receive a profit in return. Since durable medical equipment isn’t professional services, this poses challenges in obtaining payments.

Correct documentation is extremely important for DME. Attention needs to be paid when documenting and data should be rechecked before it is streamlined to coders and billers. Documentation needs to prove that the billed services were actually provided. In case of an audit, if it is found that you don’t have proper documentation, your practice will have to give that money back and also face penalties.

Considering the challenges in DME billing and the complexities involved, many providers choose to hire a third party for billing. Outsourcing their billing needs gives them access to a team of skilled coders and billers who work dedicatedly to bring timely payments for their clients.

About 247 Medical Billing Services:

We are a medical billing company that offers ‘24/7 Medical Billing Services’ and support physicians, hospitals, medical institutions and group practices with our end to end medical billing solutions. We help you earn more revenue with our quick and affordable services. Our customized Revenue Cycle Management (RCM) solutions allow physicians to attract additional revenue and reduce administrative burden or losses.

Contact: 
247 Medical Billing Services
Tel: +1 888-502-0537
Email: info@247medicalbillingservices.com