The Challenges Your Business Faces and How You Can Help Address Them

Today, medical billing remains challenging and demanding for Home Medical Equipment/Durable Medical Equipment (HME/DME) providers. In part, this could be due to the intensive type of work that the medical billing process demands. A high volume of documents is typically involved when HME/DME providers require businesses to establish the need for medical equipment they provide to the end-user.

Nevertheless, according to a Grand View Research report, the market size value for the U.S. durable medical equipment market in 2022 is USD 59.6 billion. The revenue forecast for 2030 is USD 92.8 billion, with a compound annual growth rate (CAGR) of 5.7 percent from 2022 to 2030.

Any discrepancy in paperwork, such as an unclear prescription or authorization document, could lead to the delivery of faulty medical equipment, which an end-user could inadvertently use. Non-prescribed equipment can also endanger human life and wellness, as well as the immediate caregivers and facility. Therefore, paperwork forms an essential component of the HME/DME provider medical billing process.

Some of the steps in medical billing processes and the challenges businesses face include:

#1. Registration of the Order

Registration of the order includes information on the end-user that the HME/DME provider will refer to during the medical billing process. Registration can include patient demography, such as name and date of birth, medical history, and details of illness and the prescribed therapy. This will also contain a prescription for the actual medical equipment the user requires.

Challenge Faced: In-house staff needs time and attention to ensure registration is carried out correctly. An important part of the registration process is the medical insurance details. The insurance supplier, the insurance plan, and the patient policy number are all critical elements of this detail. Missing or inaccurate information in the registration can lead to delays in receiving payment. These errors can cause delayed payments or even lead to payment denials outright.

#2. Verification of Financial Accountability

The HME/DME provider will be paid through the end-user or their insurance. However, verifying financial accountability is paramount because this will eventually ensure the HME/DME provider business gets paid. The claim submission process and eventual payment will depend on this step.

Challenge Faced: It is the HME/DME provider’s responsibility to ensure they understand who is responsible for making financial decisions for the orders placed. They must also understand that payment responsibility is established beyond doubt. Reviewing the patient’s documents during the registration process can help identify this information while helping assess whether the insurance plan covers the HME/DME prescription adequately or not. This review will also help understand payment options available if the insurance does not completely cover the cost of the medical equipment.

#3. Claim Submissions

Claim submissions differ in format but typically contain patient information, including demographics and medical history. They also contain information about the health provider and are eventually submitted to the insurance company for payment.

Challenge Faced: Claim Submission filling is a technical process and requires guidance and training. Medical billing must comply with the Health Insurance Portability and Accountability Act (HIPAA).

#4. Follow-up on Claim Submission

Have the submitted claims been accepted? Is there any delay or denial? A detailed analysis may be needed to determine the reasons for any claims that face delays in payment from the insurance provider.

Challenge Faced: Trained staff will need to review submissions to ensure they are all in order. Where needed, audits or a thorough review of an explanation of benefits (EOB) may also be required to ensure claim delays and rejections are better understood.

#5. Follow-Up to Ensure Payment

Timely follow-up on claims is necessary to ensure payment processes are followed and any information missing or lacking is furnished on time. The HME/DME provider will only receive payment on submitted claims. At times delayed payments may need active follow-up for completion.

Challenge Faced: Without timely payment, the HME/DME provider business faces sustainability and growth issues. There is no liquidity to support operations, business investments, and work on business growth goals.  

The Advantage of Professional Assistance

Some of the challenges in-house resources face could involve the following:

• Ensuring compliance with deliveries and order-taking
• Reviewing order documents and medical requirements
• Aligning orders with documents of authority
• Inaccuracy within insurance information

Here are some ways in which professional HME/DME medical billing can help:

Consistent and Reliable Assistance: Reliable support from an expert medical billing company can empower the HME/DME provider business with the freedom to pursue business-building and growth goals.

More Availability of Resources Otherwise Devoted to Training: The outsourcing partner is responsible for training and scaling up their medical billing team. This helps the HME/DME provider avoid investing in training or hiring. It helps the business save expenses.

Reduced Attrition Rates: Because the team that works on medical billing is not in-house, the HME/DME provider does not need to worry about attrition or resource burnout.

Improved business bottom lines: Outsourcing medical billing to professionals can help address high turnover and help businesses save time and money lost to training in-house resources, which eventually quit due to burnout and the lack of efficiency caused by multitasking.

Revenues also accrue when money is saved on in-house infrastructure, higher salaries, and benefits packages, among other things.

Next Steps 

• Outsourced partnerships for medical billing can provide relevant support and expertise required to reliably manage DME/HME billing, such that business profitability receives a boost. Learn more about our medical billing at https://analytixhealthcaresolutions.com/. 
• Email us at sales@analytix.com or call 781.503.9002 for a complimentary session. 
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