How many denied claims can a vendor withstand before cash flow collapses? For DME suppliers, this is not a hypothetical concern but a daily operational reality. CMS reports DME billing denial rates of 12% in Medicare Advantage, 14% in Medicaid managed care, and 18% in ACA Marketplace plans, denoting a direct financial strain on providers…
DME claims are rarely denied because a patient “does not need” the equipment. More often, the problem is that the clinical record, order, coding, authorization, or delivery documentation fails to establish that need according to the payor’s coverage requirements. For DME suppliers, this distinction is critical. Many times, the physician understands that the patient needs…
A DME billing claim can be clinically appropriate, correctly coded, and paid by Medicare, yet still become a problem months later. But the real question arrives after the payment. Can the medical record prove that this equipment was reasonable and necessary for this specific patient? For healthcare practices involved in ordering or supporting durable medical…
Got questions? Ideas? Fill out the form below & our specialist will contact you.