As per the Harvard Business Review, the top
hospitals have lost hundreds of millions of dollars of income due to revenue
leakages. As per American Hospital Association, all kinds of U.S. hospitals
reported approximately $620 billion in uncompensated care costs since 2000.
The phenomenon is especially common in the Durable Medical Equipment (DME) billing
& coding industry because of the inherent cumbersome nature of DME
billing. Revenue leakages are a major concern in the healthcare industry. They
are the difference in the claimed amount
that healthcare providers are entitled to receive versus the amount of the
reimbursement they actually receive.
Top
reasons revenue leakages happen in DME billing and coding:
- Denial of claims: 20% of
all revenue loss is due to denial of claims. Claims can majorly be denied
if:
- Demographic
Information of the patient is incomplete.
- Information
is missing or invalid.
- Medical
Necessity of DME usage is not clearly mentioned.
- CPT code,
Modifier, PIN, or NPI is incorrect or missing.
- Duplicate
claim or service is found.
- Inaccurate codes: Another
common reason for revenue leakage is incorrect coding of accessories or
equipment. Only when the DME biller identifies the right HCPCS level II
codes and sends over the claim with authorization paperwork, the insurance
company will pay the claim.
- Non-compliance: All the guidelines
laid down by the Health Insurance Portability and Accountability Act
(HIPAA) and the Office of the Inspector General (OIG) must be followed to
the last bit in order to prevent complete rejection of your claims and
thereby leakages in revenue.
- Lack of real-time monitoring: There’s no substitute to correct and real-time data. If that’s
not available and there are discrepancies in your data, be sure of major
revenue leakages. Why? Because without real-time data, decisions will not
be backed up by accurate data. For example, if the insurance policy does
not cover a specific treatment, this can be communicated to the patient
and the provider beforehand so that there are no issues in the DME
billing.
- Incorrect data: Inaccurate
data entry in the database can give rise to mismanagement of funds and
thereby revenue leakage. Until the data is meticulously collected and
analyzed by experts, error-free billing is a distant dream.
- Failure to Follow-up:
Failure to follow-up regularly can sometimes lead to non-payment of
claims. If there’s a delay or the claims are outrightly rejected, DME
billers need to follow up or resubmit the claims to avoid revenue leakage.
- Lack of expert guidance: By
now you know that DME billing is an exhaustive process and must not be handled
without expert guidance. Revenue leakages mainly happen when
non-professionals venture into it and do not adopt DME billing
outsourcing. Billing professionals can help you avoid errors, identify
loopholes, get payments on time, manage denials and rejections of claims,
and streamline the entire billing process so that you receive the payments
you deserve.
The first step to avoid all forms of revenue
leakage in DME billing and coding is to
identify the loopholes. By giving the process in the hands of experts, you
ensure that you’re focusing on what you’re best at - treating patients, which
by the way will lead to revenue generation in the long run.
About 24/7 Medical
Billing Services
24/7 Medical Billing Services is the nation’s leading medical
billing service provider catering services to more than 43 specialties across
the entire 50 states. You can rely on us for end-to-end revenue cycle
management. We guarantee up to 10-20% increase in the revenue with cost
reduction of your practice for up to 50%.
Call us today at 888-502-0537 to know more on how we can help
boost profitability for your practice.
Media Contact:
Hari Sudan, Media Relations,
24/7 Medical Billing Services,
16192 Coastal Hwy,
Lewes, DE – 19958
Tel: + 1 -888-502-0537
Email - info@247medicalbillingservices.com
Website – www.247medicalbillingservices.com
