Eliminating growth pains for a DME company by infusing scalability into their revenue cycle processes
Executive Summary
A large, durable medical equipment (DME) billing software company was looking to expand its revenue cycle management business aggressively. They knew their in-house team and manual processes would not be able to scale and would impact their profit margins. They began to search for an outsourced vendor to partner with and allocate portions of their revenue cycle management. It was imperative that the outsourced vendor be able to handle and scale with the company’s aggressive growth plan and not impact delivery for their current customers.
They chose Access Healthcare as their preferred vendor based on their expertise, technology, and people processes.
Challenges
Implement a structured and scalable solution to improve efficiency
Support hyper growth by ramping up the workforce in a short time frame, on-demand
Minimize impact on the existing business
Streamline revenue cycle workflows
The Solution
Trained and hired DME billing experts to streamline revenue cycle workflows
Applied our proprietary arc.in workflow management system to improve efficiency and provide real-time reporting
Transitioned DME revenue cycle processes successfully; set processes to ramp up on demand.
Provided scalability and dependability through structured training processes
Top Reasons for DME Claim Denials
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If the equipment or service is not considered medically necessary for the patient's condition, the claim will be denied.
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It may be denied if the provider does not submit all of the required documentation to support the claim.
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If the DME item is not covered under the patient's insurance plan, the claim will be denied.
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If the claim is missing essential information, such as the patient's diagnosis or the provider's National Provider Identifier (NPI), it may be denied.
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If the provider uses the wrong code when submitting the claim, it may be denied.
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Insurance companies have strict deadlines for submitting claims; if the provider misses the deadline, the claim will be denied.
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If the patient has multiple insurance policies, the provider must submit the claim to the primary insurance first. The claim may be denied if submitted to the wrong insurance company.
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Some insurance companies require prior authorization before covering certain DME items or services. The claim will be denied if the provider does not obtain prior authorization.
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The insurance company may deny duplicate claims if the provider submits multiple claims for the same service or item.
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Any additional claims will be denied if the patient has reached their maximum benefit for a particular service or item.
The Results
Better turnaround times for cash posting and sales orders, 48-hour turnaround
Maintained AR days, resulting in better cash flow for their clients
Improved the efficiency of internal teams making continued growth possible
Visibility to real-time analytics & reports
Refined processes and best practices to handle aggressive growth plan
Looking to streamline processes, improve efficiencies, and scale quickly? Trust Access Healthcare to deliver. Contact us at info@accesshealthcare.com