How to Reduce Duplicate Claims Denials
DME can be a complicated business for most suppliers. When dealing with medical equipment, there are many variable details that must be taken into consideration to receive prompt reimbursement. Often the little things can be overlooked if the claims are not evaluated by durable medical equipment (DME) specialists. The paperwork required for DME records can sometimes be overwhelming for an inexperienced DME manager. The paperwork, the medical necessity requirements and the inexperienced medical biller can cost a pharmacist or an equipment store thousands of dollars a year in lost revenue. Many times, claims are denied and the inexperienced staff does not understand how to appeal or research the cause for denials and the monies become unrecoverable. According to National Government Services, Inc., the Jurisdiction B DME MAC, 29.4% of all claims submitted to it for processing in the month of February, 2010 were denied for claims submission errors. 10.8% of the submission errors were due to duplicate denials. Jurisdiction B is the smallest of the four Medicare regions with only 7 states to service. 29.4% is an extremely high percentage of denied claims. How does a provider reduce his or her denial rate? Since Medicare began requiring a Part D prescription plan, health insurance has seen an increase in Medicare HMO plans. Rule #1 of filing DME insurance claims: Check the beneficiary's insurance card before releasing the equipment or supplies to the beneficiary. If the insurance card says 'HMO', the Medicare is not the primary insurer, so the claim does not get submitted to Medicare first. Rule #2 make sure the diagnosis is properly linked to the equipment. If you are entertaining the thought of supplying durable medical equipment to your community, or you do currently, make sure you choose a full service billing company to manage your DME department. Make sure the company specializes in durable medical equipment billing and has DME claims specialists on staff. You will increase your reimbursement, reduce your denials, improve your bottom line and supply DME with confidence to your patients. About Author Cindy Rushing is the Business Development Manager for Billing Management Services and an independent consultant for the healthcare industry. Cindy has almost 20 years of experience in healthcare coupled with a degree in Healthcare Administration. Disclaimer: Article submitters are solely responsible for the content of their articles. ArtiLib can't be held liable for the contents of the articles. Report Abuse | Browse By Category |
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