Tips for Improving HME/DME Claims Reimbursement
Few things upset an HME business owner more than having to write off revenue due to insurance rejections or denials. But many of the factors that lead to these rejections and denials are within your control.
The right business management software can help you automate processes, streamline workflows, and check for completeness to minimize the number of claims with the potential to cause issues. Focus on using your software to its fullest potential with the following tips:
Collect complete patient data: A blank field or inaccurate information on a claim form can prompt a rejection or hold up a claim. The same goes for missing documentation. During the intake process, be sure you gather all the data and documents you’ll need for billing. A good business management system, like TIMS Software, can help simplify the process by providing a dashboard view of open intakes and outstanding documents for a patient, showing exactly what needs to be added before you submit a claim.
Check eligibility before you dispense: Performing routine eligibility checks—especially for rentals—is a must. You'll want to make sure the patient's insurance is still current, that they have HME/DME benefits, that you're in-network, and whether prior authorization is required. The TIMS Software validation system takes the guesswork out of this process by prompting your staff to ask these questions, and getting pre-authorization is easy with auto-generated forms.
Beat the clock for timely filing: Since timely filing is based on date of service, the clock starts ticking when you dispense a product, so tracking open orders is key. TIMS Software can help you prioritize your work queues and order tasks so that your collection team works first on claims with approaching deadlines and appeal limits.
You're unlikely to completely eliminate claim rejections. So what can you do about them when they happen? First, watch your outstanding rejections closely, and make sure they're being worked every day. A strong work queue and dashboards can help you prioritize. Second, figure out why claim rejections are made in the first place. Monitor staff performance; your TIMS Software system can show you how many errors each team member has made so you can pinpoint issues and consider opportunities to provide additional training.