Managing HME billing comes with inevitable denial claims crises. In fact, today healthcare providers offering Home Medical Equipment (HME) services not only face challenges in dealing with claim denials that leave a devastating impact on revenue but also create administrative burdens and strain provider-payer relationships.
However, all these can be reduced and overall revenue generation can be enhanced by addressing common causes of denials and implementing effective management strategies.
All about the major causes of HME denials and actionable tips to manage them efficiently:
Inadequate or wrong Information: More than 42% of billing denials stem from inadequate or wrong information or data that has been provided. However, to address this issue, one can-
Ensure comprehensive documentation is correctly taken along with proper coding, documentation requirements and payer-specific guidelines being followed to ensure better claims
Implement quality control measures to review claims for accuracy and completeness before the submission of claims.
have dedicated resources who are aware of your claims submission deadline and ensure timely claims submission to avoid claims denial or getting rejected
Duplicate Claims: Busy workloads and pressure at times can lead to the accidental submission of duplicate claims on the same date of service. To prevent this:
One should work on thorough review processes and train staff to identify and prevent duplicate submissions of claims to avoid errors in future
Execute a robust claim scrubbing system that detects or identifies and flags potential duplicates before the submission.
Have clean and clear internal protocols for identifying and resolving duplicate claim situations promptly and efficiently so it does not affect much of your ROI.
Claims That Are Adjudicated: Constantly submitting a claim that has already been rejected can result in errors and subsequent denials. To address this:
Ensure a dedicated team of expert constantly monitoring and ensuring proper tracking and management of denied claims to prevent resubmissions.
Implement a system for tracking claim status and update as it prevents resubmitting rejected claims or duplicity etc.
Analyze the loopholes for the denial reasons and identify the patterns so you can make necessary changes to avoid future denials and revenue losses
Incomplete Prior Verification: Failure to complete eligibility and benefits verification before providing services is one of the major causes of claim denials. To mitigate this risk:
Establish efficient procedures and have a solid team of experienced professionals for verifying patient eligibility and insurance coverage before providing HME services.
Communicate effectively with payers to ensure service coverage and reduce denial rates.
Consider partnering with experienced outsourcing providers specializing in insurance eligibility verification to streamline the process in fat not only makes your task easy but also faster whiles saving a lot of your time and money.
Late Submission of Claims: it is no secret that all the payers set a specific timeframe for claim resubmissions. To avoid the accumulation of denied claims:
Proactively monitor submission deadlines and promptly address resubmissions.
Implement automated alerts and reminders to ensure that all your claims are submitted on a timely basis
Develop a systematic process for tracking resubmitted claims and their status for your better understanding
As now that you know managing HME denials requires a proactive and systematic approach. However, today it can be quite time consuming and costly for many HME providers. This is why today to manage HME billing and its denial management affair; providers are looking for operational extension as it guarantees a better solution.
By addressing the common causes of denials, implementing effective management strategies, and leveraging data analysis, and taking care of all your HME billing needs, an operational extension like Sunknowledge further helps in minimizing denials, improving revenue cycle performance, and enhancing relationships with payers. With constantly monitoring, analysis, and adaptation to changing payer requirements with the help of dedicated account managers and expert billers, Sunknowledge today is known for optimizing its operations and in achieving sustainable financial success in the HME industry.
So if you are struggling to manage your claims, Sunknowledge is here to help.