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Five Ways DMEs Can Manage Improper Payment Rates

by | December 17, 2020 | 6:37 am
Category : DME
Five Ways DMEs Can Manage Improper Payment

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.

Five Ways DMEs Can Manage Improper Payment Infographic
  1. Verify Prompt And Accurate Insurance Eligibility

Ensure an extensive eligibility verification process determines whether the patient is covered for DME services. For those patients who are covered, evaluate eligibility of specific types of DME services. According to CMS, the high level of errors in the 2019 improper payment rates was mostly due to insufficient verification of eligibility.

  1. Ensure Complete Documentation

Documentation is the key to accurate billing; good documentation holds strategic significance. Complete and accurate patient documentation, as well as the use of correct modifiers, provides a detailed narrative. Point-by-point documentation leads to correct and timely reimbursement. Documentation help payers conclude that the billed services were actually provided, were provided at the level billed, and/or were medically necessary. The U.S. Department of Health and Human Services, in its 2019 Medicare Fee-for-service Supplemental Improper Payment Data report, highlighted the top root causes of insufficient documentation errors in DMEPOS.

  1. Avoid Insufficient Documentation

Simple errors can trigger a claim rejection or denial. It therefore becomes imperative to reduce the chances of insufficient documentation errors. The billing team must accurately record and document patient health information after a one-to-one personal examination, either at the time of patient registration or prior to raising an order. Yet another critical measure is to determine the relevant and specific codes that the detailed written order requires.

  1. Submit Precise Documents

Submit the relevant documents that confirm the medical necessity and help to precisely reflect the condition of the patient. Submitting important medical records and documents such as a provider’s prescription, a patient’s medical record, and any clinical documentation helps make an informed decision that the services billed were medically necessary based upon Medicare coverage and payment policies.

  1. Analyze and Improvise

Streamlining your DME billing process is not sufficient to improve collection rates and cash flow. An efficient revenue cycle management requires continuous work and regular audits by an expert team. Analysis and insights into the changes to address and items to remove are an important element of the process. This helps increase cash flow and optimize your revenue cycle for your DME’s success.

Analytix – Your Medical Billing Partner

For some companies, it makes sense to outsource a portion of medical billing, such as insurance verification and charge entries. Analytix Solutions works with DME and HME practices and businesses to identify and implement medical billing processes that can be streamlined and optimized. We are HIPAA compliant, possess an ISO certification for secure data, and offer flexible engagement models and payment structures.

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