Data Policy and Procedure for DME/HME

Policies can be overwhelming, with a great deal of information and fine print. They are necessary, however, in any thriving business.

DME/HME payments are dependent on the accuracy of the information contained in the claim. If information is incomplete or missing, the claim processing can be delayed or denied. Ensuring patient records are in order is critical to the claim application process.

The data that is referred to by DME/HME businesses is often patient information or personally identifiable data. From authorizations for equipment to diagnoses and any updates or modifications to medical equipment use, DME/HME businesses must keep ahead of records to ensure there are no lapses when it comes to settling dues.

All personally identifiable data is governed by the Health Insurance Portability and Accountability Act (HIPAA). All processing, handling, and working with patient data must comply with HIPAA guidelines. Patient rights need to be in view at all times so that medical data and personally identifiable information is handled in accordance with regulatory and statutory requirements without conflict of interest.

Businesses can draft policies that can serve as references for any clarification, especially for patients, their insurers, or third-party auditors. Procedures are different from policies in the sense that they detail the steps and action that must be taken. They can be combined and your business can have a single document for listing both policy and procedure.

Policy and Procedure Considerations

Here are some considerations that DME/HME businesses should keep in mind when drafting policies and procedures.

• Accessibility: The content should be accessible to all relevant audiences and stakeholders of your DME/HME business.
• Customizability: Content of policies and procedures can be customized to your business and needs. The idea that a policy is some kind of rulebook that cannot be adhered to may be incorrect. Instead, policies can be drafted keeping in mind the existing resources, staff, people engaged in the business, and the actual work carried out by them.
• Storage: Some businesses still prefer to keep both online and a paper version for their own reference. The paper version, bound as a book, works well as a ready reference by the staff, especially when they need guidance.
• Organizational hierarchy details: Organizational structure details can help staff understand how the business hierarchy is formed. This is particularly useful when questions regarding reporting and accountability need to be addressed.
• Conflict addressal: Policies can directly address the issue of conflict within the DME/HME business. Guidelines on addressing conflict can be detailed to ensure that any actual conflict is handled without affecting the business.
• Scope of services: The scope of services can also be outlined and defined to list out exactly what your business expects to deliver. Outlining the scope of services can help prevent conflict between expectations and reality for customer deliverables.
• Staff guidelines: Business policy must cover guidelines for staff. Human resources guidelines can help employees and employers alike. These are particularly important for businesses that already have a sizable number of employees or are looking to add to their staff in the near future. Keep in mind that DME/HME employees and staff need to understand paperwork and record-keeping, in addition to medical knowledge. Regular updates and review of patient records may be necessary to ensure no authorizations are outdated or additional information related to insurance is missing.
• Storage, use, and sharing of information details: Policy documents need to detail how patient information is stored and utilized, including sharing where needed, with other parties and not just the DME/HME and its staff. Typically, businesses must include their disclosure policies on how information is stored and shared, especially outside the DME/HME.
• Records retention: The policy will also need to include details on how long the business aims to preserve medical records of patients and what is the intended action to be taken on retaining these records after a particular time period.
• Details of equipment usage: Depending on the unique business needs, you may need to include details on usage of the equipment. This may include procedures for proper storage, use, and maintenance of medical equipment, as well as pre-and post-delivery directives, wherever needed.

Other elements that can be included in a policy document may be clearly outlined procedures for strategic growth, articulated intentions on how business growth and development will proceed, and if needed, a complete program for training and development of the staff as well.

Directives on managing crises and disasters can also be included to ensure the business does not run out of available cash if the need arises.

Action item: DME partnerships

Given the critical role played by policies and procedures, especially in DME billing, DME/HME businesses should consider professional help. This can help ensure nothing is missed, and that critical elements for everyday operations as well as long-term growth goals are supported and complied with.

Next Steps

• A DME partnership can provide the right assistance and expertise to reliably manage DME/HME billing requirements, including data management, such that the business can continue to focus on providing quality healthcare.
• Email us at sales@analytix.com or call 781.503.9002 for a free session.
• Engage with us on LinkedIn and Twitter.