Provider Solutions

Providing billing services for Durable Medical Equipment (DME), or Home Medical Equipment (HME) as they are sometimes called, can be a time-consuming and tedious affair. Among other things, it requires in-depth knowledge of reimbursement guidelines for Medicare, Medicaid and Commercial Plans. It also requires a constant adherence to quality and staying abreast of all the changes happening in reimbursement regulations, coding and documentation requirements.

We have a highly capable team of DME billing experts who can make life easier for you from the very first day. With us by your side, you can leave all your DME billing worries to expert care. Outsourcing your DME billing requirements to us will allow you and your staff to concentrate on marketing, growing and running business operations, rather than managing a billing and collections department.

Our experience shows that the process for DMEPOS billing can be cumbersome due to its inherent nature, viz. the order getting generated from a physician’s office. This increases complications and the turn-around time as dependencies increase. DME, Prosthetics & Orthotics companies need to devote much time coordinating and communicating with the ordering physician’s office for a valid Rx, medical/therapy notes, etc. Equipment that requires prior authorization also involves innumerable follow-up calls. This is managed effectively by us through a methodical and streamlined process that tracks each request in detail ensuring timely follow-up. Payer guidelines are specific to diagnosis, and a thorough knowledge of this result in drastically reducing denials. Our diligent physician and payer follow-up activities also help reduce turn-around time and improve cash flow. The process starts with entry of orders and ends when the account has zero balance. This includes conducting eligibility checks, obtaining authorization, creating sales orders, scheduling delivery, submitting claims, managing rejections and denials, and proactively following-up AR.

HIGHLIGHTS

• Follow-up on incomplete prescription with physician’s office
• Follow-up for document collection (diabetic verification forms, LMN, CMN etc.)
• Error free patient entry
• Error free sales order creation
• HIPAA compliant
• Real time transaction audits
• Primary and secondary insurance verification
• Insurance verification for rental items
• Obtaining authorizations & extending authorization
• Open order audit and clean-up
• CPAP user compliance tracking and counseling calls to non-compliant patients
• Claims submission within 48 hours of receiving proof of delivery
• Rejection follow-up within 24 hours
• Tracking and follow-up of partial or incorrect payments
• Denial management based on detailed analysis
• Methodical and proactive AR follow-up
• Timely payment posting to reflect accurate AR
• Customized reporting
  • Claims submission
  • Collections
  • Denials
  • Accounts receivables

Our medical coding and billing services are designed to address a wide range of issues and challenges faced by hospitals and physicians while realizing payments. By leveraging efficient processes and billing workflows, we help to improve productivity and quality, which in turn reduces operational cost and boosts revenue generation. Our billing process experts can provide customized solutions to help you achieve your business objectives. These solutions not only dramatically improve efficiency in a manner which is surprisingly cost-effective, but also allow you to focus on the more important aspects of your business.

Medical billing involves accurate interpretation of SOAP notes for correct coding combinations based on payer specific guidelines. A thorough understanding of the nuances associated with various physician specialties is required. This drastically reduces denials, which in turn leads to a significant reduction in days in AR. Denials due to incorrect entry of demographics are minimized through our transaction based internal audit mechanism. Rejections are worked as a priority to reduce turn-around time and detailed analysis of denials helps identify changes in payers’ reimbursement guidelines. Systematic follow-up is also conducted that minimize the possibility of untimely denials while ensuring their early identification, requests for medical notes, etc. All claims that have not been closed out in the system are categorized by age and insurance for effective management of the follow-up process. Billings of secondary claims are also followed up to reduce the patient’s financial responsibility while ensuring better collections.

HIGHLIGHTS

• Accurate coding combination, i.e. service code, diagnosis code, modifiers and place of service code
• Error free patient entry
• Real time transaction audits for patient and charge entry
• Claims submission within 48 hours of receiving patient (demographic & insurance) and service information
• Rejection follow-up within 24 hours
• Tracking and follow-up of partial or incorrect payments
• Denial management based on detailed analysis
• Methodical and proactive AR follow-up
• Timely payment posting to reflect accurate AR
• HIPAA compliant
• Customized reporting
  • Claims submission
  • Collections
  • Denials
  • Accounts receivables

Our AR follow-up process monitors and proactively pursues collection of payments. All claims that have not been closed out in the system are categorized by age and insurance for effective management of the follow-up process. Calls are initiated for claims that are 31 days old or more. We attempt to identify the source of the problem through proactive calling so that the turn-around time on collections can be reduced.

Diligent follow-up for paper submissions ensures that “claims not on file” are resubmitted within filing limits. Weekly AR Reports are analyzed and reviewed to prioritize work for the week. All interactions with payers are documented in detail, making repeat follow-ups streamlined and more effective. Our experienced team is adept at gathering information through appropriate probing questions. Findings are communicated with clients through a detailed report on a daily basis. The report also includes suggestions for actions to be taken from the client’s end e.g. resubmitting with medical notes, or with modifier/coding changes, and so on.

Every cash amount receives the same degree of attention as the other, irrespective of its size or source. Combine that with our high accuracy standards and you can rest assured that every penny you are entitled to will be claimed and recovered by us in the shortest possible time! Moreover, our knowledge of pertinent federal laws and acts such as EMTALA (Emergency Medical Treatment and Labor Act), ERISA (Employee Retirement Income Security Act), the Prompt Pay Law and others, help in resolving issues and settling accounts much faster than other AR Managing companies.

HIGHLIGHTS

• Streamlined and improved workflow using effective tracking tools
• Multiple follow-up calls for same claim
• Follow-up on all paper submissions
• Payer specific analysis
• Detailed reporting with suggestions for actions to be taken
• Improved cash flow
• Reduction in turn-around time
• 100% HIPAA compliant