How to Tackle Improper Payment Rates?Posted by Selena Golebiewski on July 3rd, 2019 According to CERT (Comprehensive Error Rate Testing) data, the DME billing landscape witnesses an inadequate payment rate of approximately 39.9% that drains out USD 3.2 Billion from the Medicare Fund every year. This error rate is three times higher than the overall National Medicare improper rate, which is currently pegged at 12.1% The above statistics assert that it has become critical to figure out the principal reasons behind this improper payment rate, and accordingly layout effective measures to reduce this figure. But first, let’s highlight the reasons for this anomaly:- 1. Incomplete Documentation One of the biggest reasons behind medical billing errors is inadequate documentation. In fact, this accounts for USD 2.6 Billion of the annual USD 3.2 Billion loss borne by the Medicare Trust Fund. Some of the common incidents of these prevalent errors are:-
2. Medical Necessity Denials This error occurs when the treatment of a patient does not appear to match the medical necessity criteria as covered by Medicare and other payment policies. 3. Inappropriate Usage of Modifier Using invalid modifier combination is one of the reasons behind DME denial. Along with accurate coding of treatment, it is important to bill the medical claims with right usage of modifier combinations. 4. Coding Errors Some of the most common DME coding errors comprise of:-
How to Overcome These Challenges?
Your insurance verification team needs to carry out an extensive verification process to determine whether the patient is insured and covered for DME services. Moreover, if the patient is covered, the team must further ensure the kind of DME services that the patient is eligible for.
Here are some accurate ways to document your DME:-
Even the smallest mistake of missing out one signature can deposit your claim in the “insufficient documentation error” category. This can prolong the entire process and also act as a primary reason for denial. Here’s how you can mitigate insufficient documentation errors:-
To ascertain medical necessity, you to need to submit precise documents that support the requirement of the DME. Some of the important documents required in this case are:-
Address and Amend Taking the above mentioned necessary steps can streamline your DME billing process and further amplify your collections and revenues. However, just curating an effective plan is not enough; you also need a proficient team who can put that plan into action. Additionally, it is also important to continuously review the progress in order to determine what’s working and what’s not in order to garner maximum reimbursements from your claims. Like it? Share it! |