Medical billing can be horribly tedious and very time-consuming for HME & DME practitioners! The problem appears to be getting worse! The number of exposed records more than doubled year over year, from 5,138,179 records in 2017 to 13,236,569 records in 2018. Moreover, the penalties for HIPAA violations can be severe. It is difficult to keep up with the constantly changing rules, regulatory requirements, and technologies in the medical billing field. Therefore, finding the right medical billing company becomes crucial to running your practice. Outsourcing medical billing offers health practitioners increased control, reduce overhead costs, and secure the medical billing…
According to one report, the US DME market size was valued at $52.9 billion in 2020. This is expected to expand at a compound annual growth rate of 6% over the forecast period from 2021 to 2028. As DME/HME businesses settle into a year of rebuilding and recovery, while continuing contactless transactions, it is time to review and assess business processes, including patient eligibility in insurance. For a startup DME/HME, there is often a difficult decision between attending to medical requirements and completing diligent record-keeping. Importance of patient eligibility verification DME/HME businesses almost always get paid based on the success…
A DME/HME is paid only after the insurance claim is made and processed effectively. One of the critical components of successful claim processing involves making sure the information submitted for claim processing is complete and correct. Incorrect claims can lead to denials. According to a report by the American Hospital Association, quoted in an online report by Revcycle Intelligence, a healthcare media company, 89% of hospitals and health systems have experienced an increase in claim denials over the past three years, of which 51% termed the increase as significant. Here we outline two practical ways for DME/HME claim denial management…
For a DME/HME, choosing between providing timely and high-quality patient care and focusing on business-building practices, can seem unending and frustrating. If delivering effective therapy is the driving force for a DME/HME, then effective financial management is the way to ensure focus on deliverables remains primary. Revenue cycle management is central to DME/HME sustainability. A MarketWatch report says the North America healthcare revenue cycle management market is expected to witness a compound annual growth rate (CAGR) of 11% from 2019 to 2026. An expert billing partner provides a number of benefits including: Efficient billing process The billing process begins at…
Ensure accurate registration patients or rush to catch a prospective new business lead that could boost your DME/HME by a few thousand dollars each month? Accurate registration is vital for patient payments to your DME/HME, while following new business leads could help bring in more revenue. This may be the classic predicament faced by owners and founders of startups and small DME/HME businesses, with no immediate or easy solutions in sight. Over the past year, most DME/HME businesses have had to multi-task: managing regular orders, dealing with COVID-19 complications, and dealing with other challenges, including financial worries. For DME/HME startups…
Medical billing can be complex and challenging, especially when combined with the details and intricacies of insurance. Payment for most healthcare facilities depends on how swiftly and accurately they process insurance claims. Efficient handling of insurance leads to better claim processing. It also reduces the administrative burden of high-volume paperwork and record-keeping. Simplification of the medical billing processes is not just an option, it is a necessity for healthcare businesses that want to stay sustainable and thrive in a competitive environment. According to reports, the average rate of claim denials in the healthcare industry is between 5% and 10%. To…
Administrative complexities can hound high-volume hospital, DME/HME, and other healthcare business data, eating into time and attention that would otherwise be spent delivering patient care. Owners and operators of small healthcare businesses are often also responsible for registrations and records. The requirement to multi-task can result in lapses in information, which in turn can lead to incomplete claim submissions and lost payments. By outsourcing medical billing processes, businesses can access high-level expertise within their budget. This expertise can help the business build a roadmap to streamlined operations, higher productivity and efficiency, and long-term growth. A report by MarketWatch estimates that…
The Health Insurance Portability and Accountability Act (HIPAA) helps protect confidentiality and security of health information. HIPAA guidelines also focus on fraud prevention and ensure both data security and better regulation of health information. For this reason, DME/HME businesses must look at billing solutions that are HIPAA-compliant. HIPAA covers the following information: Patient information put into medical records by doctors, nurses, and other healthcare providersInformation exchanged by patients with doctors, nurses, and healthcare providersHealth insurance-related information and information held by the health insurance providerPatient billing information Significance of HIPAA compliance For every patient, health information is sensitive. This sensitive information…
According to the Comprehensive Error Rate Testing (CERT) data, even as the overall payment rate stood at just 7.25%, DME billing error rates contributed to 30.70%, and drained $2.44B from the Medicare Trust Fund. In the post-pandemic "new normal," it is important to provide clean paperwork and documentation to avoid mistakes and reduce improper payment. Error-free submissions require that the medical billing team avoid common reasons for improper payments, such as insufficient documentation, inadequate documentation (needed to make informed decisions), or incorrect coding. Review these effective measures to decrease improper payment rates in DME billing. Verify Prompt And Accurate Insurance…
Whether during periods of intense business activity, or during a crisis like the current pandemic, which has affected economies globally, efficient medical billing is the only way to ensure year-round financial sustainability for DME/HME businesses. For startups and small businesses, with just enough cash to cover two weeks’ worth of expenses at any given time, smart revenue management holds great significance. Revenue management may begin with diligent bookkeeping and accounting practices, but there are ways to improve the overall revenue management cycle. The need for accuracy and reliability An online report by Patient Engagement HIT describes the frustration that 70%…
The choice to conduct your practice’s medical billing in-house or to outsource it to a medical billing company is probably one of the most important decisions you will make for your growing healthcare practice. In fact, according to Grand View Research, the global medical billing outsourcing market is expected to reach $19.7 billion by 2026. While there are pros and cons to each approach to medical billing, what matters most is what's right for your medical practice. While in-house billing offers you more control, since you remain in proximity to medical billers, it also requires significant investment, takes precious time…
More than 3 of 4 healthcare leaders agree that claim denials are their major challenge. We have heard the horror stories DME providers tell of denied claims. Maybe you have a similar story of your own. The good news is that most claim denials are avoidable and as the old saying goes: "An ounce of prevention is worth a pound of cure." With a 30% rate of claim denial, there are many challenges for small and growing DMEs/HMEs. Claim denials are a time-consuming and complicated process that prevents timely reimbursements. Given that denial rework can cost $118 per claim, it…
Time is money. The complications of completing your DME’s medical billing can be horribly tedious and more overwhelming than the core of your DME business – improving patient outcomes. And then, upon submission, claims must be clean to even receive consideration. As an HME/DME provider, although a majority of your time must be spent on patient care, gruelling administrative chores and cumbersome everyday billing tasks can be overwhelming and distracting from providing the quality your patients deserve. Moreover, financial losses from the pandemic may have a lasting effect on DME providers, and outsourcing medical billing may be the best way…
Medical billing management is critical for a DME/HME to thrive and grow in all situations, including crises. According to an online report by Advisory Board, 90% of claim denials are preventable. Given that claim processing depends on financial data and patient records, it makes sense for healthcare businesses to rely on dependable medical billing management practices. For a startup or a small-size DME/HME business, an ongoing dilemma may be the choice to focus on providing superior healthcare or to work on growing the business. It is important to realize that if your business is doing well, the quality of healthcare…
Electronic records are a reliable way to record important information that would otherwise be lost. Paper records, receipts, and invoices can be misplaced and are often difficult to access when needed the most. This includes medical documents vital to DME billing, including prescriptions, authorization notes for prostheses, treatment advisories and more. For a healthcare business, the loss of or inaccuracies in any of these critical documents can mean the difference between getting paid or not paid. Even in pre-COVID-19 times, the figures for medical bill payments were bordering on dismal. A Becker’s ASC review reports that in 2016, as many…
Prevention of billing revenue loss is an ongoing challenge for most small businesses in the healthcare industry. This is not confined to a time of crisis such as the COVID-19 pandemic. Even in normal times, the typical small business possesses enough cash to cover about two weeks of revenue disruption, according to a report by JP Morgan Chase & Co. According to another study, a business with monthly expenses over $10,000 generally doesn’t have enough cash to cover two weeks of their spending. This suggests that a company in this situation would either have to fold or drastically cut spending…
If businesses can manage a crisis well, they emerge stronger than before. In the current situation, companies that adapt to change are likelier to emerge more resilient and tougher from it. COVID-19 has led to large-scale lay-offs and a bleak economy, affecting typical small businesses where it hurts most: lack of adequate staffing and reduced financial capabilities. For a DME/HME business, challenges include ensuring supply while managing logistics and facilities burdened by the COVID-19 pandemic. DME/HME businesses looking to emerge stronger from a crisis, consider: Identifying challenges and looking for resolutions Businesses, including your DME/HME, are vulnerable to disruptions in…
According to InstaMed's Tenth Annual Report, patient collections take more than a month for 74% of healthcare providers, and over 78% said they cannot collect bills of more than $1,000 in 30 days. These delays in patient collections are creating revenue cycle issues for providers and 66% of providers agreed that patient receivables are a primary revenue concern. The solution? Outsourcing your DME billing is often the best choice. Choosing the right medical billing company is - not surprisingly - easier said than done. It is all about asking the right questions. Read on to learn key tips to choose…
If you are a DME/HME considering whether it would be beneficial to attend medical conferences and networking events, here are some compelling reasons you should. In the time of COVID-19, conferences and events are online. So, as a DME/HME owner looking to grow your business, you stand to gain a lot by attending as you can: Hear about common struggles faced by others in the industry and how they overcame them, and were able to grow their business.Gain additional information through transfer of professional knowledge.Learn more about how to make your own business operations smart, hear about new software and…
Recordkeeping is a major part of medical billing and one that can quickly disrupt a DME/HME business owner’s productive time. In addition, storing records, ensuring safety, and allowing easy retrieval increases a business owner’s need for time and attention. Professional medical billing services can assist in a great deal of recordkeeping responsibilities, allowing business owners time to pursue their passion: using products and services to enhance the quality of life for patients. Engaging a professional medical billing partner can increase the profitability of your DME/HME business by: Creating Accessible Records Patient registration is an intensive task for DME/HME businesses. Stringent…
For a DME/HME, patient concerns often come bundled with the added element of required urgency. Based on a report by the Centers for Medicare and Medicaid Services (CMS), the need to rapidly reach medical care has led to video consultations, rather than in-person consultations, in times of emergencies. This innovation has helped countless people receive medical care during the time of the COVID-19 pandemic. The report also highlights a surge in telemedicine service beneficiaries during the pandemic. While only 13,000 beneficiaries of fee-for-service Medicare received telehealth services weekly in the pre COVID-19 times, the number exhibited a steep rise to…
Durable Medical Equipment (DME) billing is a demanding and challenging practice. According to the Medical Group Management Association's poll, 71% of healthcare leaders agree that claims payment and revenue cycle issues — such as denials, prior authorization, and staffing issues — are the biggest revenue cycle challenges. COVID-19 has introduced DMEs and Home Medical Equipment (HMEs) to a new operating environment. They need to manage new regulatory, financial, and operational challenges while also providing value-based care. Outsourcing DME billing makes sense for both ensuring ongoing profitability and for the reasons listed below. Better monitoring and control Outsourcing your medical billing…
According to a Forbes report, it was estimated by Statista that the US market value for health and wellness would rise from $166.5 billion in the year 2015 to $179 billion in 2020. The report further quotes research that estimates the growth of the retail health clinic market at a combined rate of 18.3% between 2019 and 2030. When the report was published, however, the crushing effects of COVID-19 had not yet been documented. Certain challenges that were faced before the COVID-19 pandemic remain unchanged for the HME/DME business. One of these remains - effective Revenue Cycle Management or RCM.…
Denial of a claim refers to refuting payment for a medical bill in the medical billing business. As a result, knowing how to manage and reverse a denied claim is vital for successful medical billing management. According to a Becker’s report, the standard denial rate benchmark is less than 5%, though a rate of 1% is achievable. The reality is, that every percentage denied is payment not received. For a startup or a small business, any denied payment can hurt the bottom line. Claims denial in medical billing may include several prospects: Possessing knowledge and the experience on how to…
Do high account receivables plague your practice's cash flows? Let's face it, the COVID-19 crisis has led everyone, including patients, to hold on to their money tightly. As COVID-19 pandemic transforms patients’ needs and their ability to pay for healthcare, DME’s must adopt a more effective, patient-friendly medical billing options. The need for strategies to boost A/R has never been greater as DMEs themselves face financial challenges. Medical practices are under immense pressure to maintain healthy cash flow and meet operating expenses. Unfortunately, many medical practices are leaving money on the table due to inefficient A/R management. According to a…
Mistakes in medical billing can jeopardize the reputation of your medical practice and hurt patient loyalty. The trust deficit created due to inaccurate medical billing can be irreparable. According to the 2019 Patient Payment Technology Report, based on a survey of 1000 U.S. healthcare consumers, only 33% of consumers expressed confidence in the accuracy of the bill provided by their hospital/ caregiver, while 47% reported facing a billing or payment issue in their recent healthcare experience. Patient billing is a critical part of maintaining your HME's brand loyalty and retention. Errors in billing can translate into financial losses. In addition,…
Analytix, a leading medical billing solutions company, joins the Pennsylvania Association of Medical Suppliers (PAMS) as a gold member. The membership in this elite group enables Analytix to help independent HME and DME practices achieve high billing performances as well as drive solutions to the Pennsylvania HME industry. As the oldest state association of its kind in the country, the Pennsylvania Association of Medical Suppliers remains an active voice in durable medical healthcare in the state of Pennsylvania, Delaware and the rest of the United States. It represents Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS) Suppliers from Pennsylvania and…
As most providers can attest, when running a healthcare practice, accurate patient billing is critically important. Billing errors can lead to severe consequences, including a loss in revenue, increased claim denials, costly reworking of claims as well as heavy fines and penalties. It is estimated that a staggering 80% of medical bills contain errors. With thousands of medical codes, hundreds of patients, and multiple insurance companies, much of a practice’s time is controlled by the medical billing process, but it doesn’t have to be. The best solution is to partner with a medical billing company that works as an extension…
Analytix joined the American Association for Homecare (AAHomecare) as an affiliate member. AAHomecare is the premier nationwide advocacy group representing providers of home medical or durable medical equipment and services. The AAHomecare Association advocates on behalf of the entire homecare community in legislative and regulatory arenas at the federal and state level. Its members are focused on improving the lives of their customers and patients. Also, they ensure that the HME industry is well-positioned to succeed within the new value-based care economy through regularlegislative, regulatory, and public relations campaigns. As an AAHomecare affiliate member Analytix receives access to a wide…
Prior Authorization (PA) can be a frustrating and time-consuming process. In fact, 86% of physicians describe the administrative burden of prior authorization as high or extremely high. 90% of healthcare providers reported a treatment delay caused by Prior Authorization. Of these, 60% said it took at least one business day to receive a reply, while 26% reported that acceptance was received after three or more business days. More than 9 in 10 physicians said that the Prior Authorization process delays patient access to necessary care. On average, practices file an average of 29.1 PAs per physicians per week. Why is…
Claim denials have become a fact of life for HMEs/ DMEs yet studies show that up to 90% of claim denials are preventable. If proper care is not taken, medical billing errors may arise, leading to delay in payments, delinquency in claims, and eventually patient disappointment. Quick and accurate verification of a patient’s eligibility and authorization of insurance coverage can help reduce claim denials and even protect patients from unexpected medical bills. Outsourcing medical billing is a good strategy to streamline the insurance verification process, increase acceptance, and lower claim denials. Here are some major benefits of outsourcing medical billing…
High AR (Account Receivable) days are red flags that can negatively impact the bottom line of your practice. According to hospital benchmarks, AR days for facilities are 47.5 days, and anything above that means less money to hire quality staff, fewer margins, and capital for expansion. Regular, proactive follow-up of outstanding claims is critical to improve medical AR daysand efficient medical billing services. Thus, the lower the number of AR days, the faster you get paid and the healthier are the operations. Therefore, it is important to have your AR team follow-up all the pending claims, investigate claim denials, and…
Billing errors are not only bad for patients but also for medical practices. It’s critically important for healthcare providers to minimize any coding and processing errors to increase their revenue. Frequent claim denials and negligence may also trigger billing audits and investigations which may not only damage the HME/ DME’s reputation but even attract penalties and fines. With reports suggesting errors in 80% of medical bills, addressing these four medical billing errors becomes very critical. Incorrect Patient Information Accuracy is the critical part of the medical billing process. Even slight technical errors like a typo can result in claim denials.…
Claim denials can be frustrating for any medical practice. They not only lead to high administrative costs but also impact your reputation as a reliable healthcare provider. In addition, appealing denied claims can be a time-consuming process, straining an already overworked administrative team. We identified the 7 most common reasons for claim denials to help you plug the gaps and manage the process better. Incorrect or Missing Patient Information A simple typo can trigger an immediate denial. An omission or incorrect information entered by a provider or patient (missing payer ID, incorrect plan code, no social security number, name, address,…
Insurance verification is the first and most significant step in the medical billing and coding process. Today’s continually changing and increasingly complex healthcare environment requires, more than ever, close attention to validating coverage, benefits, co-payments, and deductibles. Thus, it becomes crucial that medical care providers understand the insurance verification process and its importance in the healthcare industry. Insurance Verification Process Simply put, insurance verification is the process of contacting the insurance company to determine whether the patient’s healthcare benefits cover the required procedures. Also, it is necessary to complete insurance verification before a patient receives medical services. Failure to do…
In the past, most DMEs, HMEs, and practitioners were doing their medical billing in-house. However, more recently, with ever-changing regulations in the medical business, implementation of the complex ICD-10/ ICD -11 coding system, and a federal mandate to implement EHR (Electronic Health Records), various companies are now outsourcing their medical billing requirements. In fact, the global medical billing outsourcing market is expected to reach $19.7billion globally by 2026. Technology is the key for DMEs and HMEs to automate the back-end revenue cycle process, either in-house or through outsourcing. What matters most is what’s right for your practice. We’ve outlined a…
Medical billing can be demanding and challenging! This is true especially for small medical practices like HMEs and DMEs where a major challenge with their in-house medical billing services is the management of human resources. Outsourcing the medical billing process allows your human resource management department to contribute to the bottom line in many ways. It does not just address key aspects of HR's traditional roles like high employee turnover, retention, and other administrative tasks. Instead, it allows HR to efficiently ensure billing compliance with HIPAA Security Rules. Key Benefits of Outsourcing Medical Billing Process Efficient HIPAA Security Rule Compliance…
Patient records, 15,085,302 in total, were breached in 2018 as per the latest Protenus 2019 Breach Barometer Report. This total number of affected patient records is triple the 2017 data (5,59,438 affected patient records). Stealing Protected Health Information (PHI) is fast becoming a lucrative business to cybercriminals. They have almost doubled the number of cybersecurity attacks to target valuable healthcare data. In fact, CNBC reported that your social security number and credit card information might fetch $2 and $10 respectively on the black market while your electronic health record (EHR) could go for up to $1,000. Today, even as most DMEs…
Medical billing is time and labor intensive, regardless of the size of your business. To successfully complete the task, you must not just have a detailed understanding of reimbursement guidelines, including Medicare, Medicaid, and commercial insurance plans, but must also be detail oriented and focused on the task at hand. Benefits of Outsourcing Rather than hiring and training a medical billing team to address your needs, medical billing outsourcing gives you access to highly experienced individuals, well-versed in the latest requirements and regulations. This not only reduces your labor costs, it give you the peace of mind that the tasks…