How Technology Can Prevent HME Billing Denials?

Frequent denials and rejected claims are two of the most significant factors affecting a practice's revenue cycle. It is beneficial to understand the fundamentals of claims denials in order to better manage the revenue cycle of HME billing claims.

This includes:

  • Collecting correct patient information
  • Determining insurance coverage
  • Eligibility and submitting claims

The Leading Causes of Medical Billing Rejections

There are two kinds of denials:

  • Hard denials
  • Soft denials

Hard denials are irreversible and result in lost or written-off revenue. Soft denials are temporary rejections that can be reversed if the provider corrects the claim or sends additional information.

According to the 2013 American Medical Association National Health Insurer, the following are some of the most common reasons for DME/HME billing denials:

  • Incomplete Information
  • Billing Duplication
  • CPT or ICD-10 codes that are no longer valid
  • Modifier Problems
  • Incorrect filing

Technology's Role in HME Billing:

Using technology to mitigate dangers

The complexity of HME billing puts a lot of pressure on practices because many processes are unlikely to catch common errors like duplicate billing or incorrect CPT codes. This is an area where technological advancements can have a significant impact. For example, it can automate CPT code updates across the practice, reducing the risk of using an out-of-date code.

Technology can also help with prior authorization by guiding staff through the critical steps of determining patient eligibility. There is no substitute for adequate staff training and education, to be honest.

Use of updated technology

The new technology-assisted method allows front desk staff to verify patient eligibility with the insurance company prior to an appointment. When a patient produces their insurance card at check-in, any eligibility difficulties can be resolved immediately. If this is done ahead of time, the patient will have a better experience, and the practice's check-in and DME/HME billing procedure will be smoother.

What are the most important takeaways?

As a result, many practices are left feeling powerless because the claim is frequently denied. However, a closer look reveals that many denials could have been avoided. If you fix the leaks mentioned above, you'll see an immediate improvement in your bottom line.

You can also save time and streamline operations, allowing you to focus on delighting patients. To begin, follow these simple instructions:

  • Examine your practice to see if any of the most common denial reasons apply to you.
  • Employees should be trained and retrained to recognize and avoid common mistakes that result in denials.
  • Think about RCM technology that can help you automate the HME billing process.
  • Start keeping track of your progress to see how much money you can save by avoiding denial-related leakage.

What Sets Sunknowledge Apart?

We've had a lot of success recovering pending collections over the last decade, working with some of the largest HME companies with excellent references. We are one of the few RCM firms that can provide both full service and a stand-alone solution.

Our AR continuous monitoring experts assist you in collecting 80% of claims that have been pending for 90 days or more. As a result, all of our clients benefit from efficient cash flow.

As your billing partner, Sunknowledge has the ideal action plan for DME/HME billing. Our team combines all of the requirements and generates a detailed report that is tailored to your specific requirements.

Our team works with all major practice management/EMR/proprietary billing systems, performing task-specific activities such as:

  • Eligibility verification
  • Prior authorization
  • Denial management
  • Accounts receivable recovery

Our services include both coding and billing. Sunknowledge defines your HME billing collections in the best possible way at 2% of collections or $7 per hour. Due to our effective communication and understanding of all new medical billing regulations as well as current industry mandates, we provide the highest productivity metrics and believe in serving as a reliable operational extension for the industry's biggest names.

Unlike any other RCM vendor in the healthcare industry, our team can assist in your DME/HME billing remotely during pandemics. Whereas most other RCM vendors are struggling to meet their productivity targets, Sunknowledge continues to set the industry's highest productivity benchmarks.