How To Implement a Faster DME Prior Authorization Process?

As a DME service provider, managing medical claims following the industry’s claims adjudication regulations is a top priority. DME Prior authorization remains a source of concern for providers, as seen by rising costs. A smooth and successful DME PA process necessitates a high level of ability and experience. Because authorization is a complex process, having an untrained person handle it can only result in lengthy prior authorization protocols hindering patient’s access to care and impaired patient clinical outcomes.

A DME prior authorization may be rejected and not reviewed for a handful of reasons. The following are the most prevalent reasons for authorization rejections:

  • HCPCS codes are not subject to prior authorization
  • Requests that has been duplicated
  • A request was sent to the wrong jurisdiction
  • Delay in authorization request submission

However, comprehensive authorization knowledge, as well as proper completion of the HME/DME prior authorization coversheet, and rigorous absorption method, can not only lessens most authorization rejections. It also guarantees a faster and seamless DME PA solution. The federal situation is highly complex, and most healthcare providers are concerned about the transparency of provider rates.

The AMA Report

According to a recent AMA poll, prior authorization processes are responsible for 92% of patient care delays and may impact on patient safety concerns as well as operational bottlenecks. DME prior authorization processes are crafted to assist in providing the best care at the exact time, resulting in a better care management process. Today, with advances in medicine and technology, as well as changing regulations, the authorization process is quite difficult to navigate increasingly complex medical policy guidelines and regulations.

Indeed, without proper information, it can be incredibly difficult to understand prior permission and medical policy regulations, which frequently perplex clinicians. Processing hospital prior authorization requirements is not only complex and labor-intensive, but also time-consuming, leaving healthcare practices with less time to focus on patient care management.

Increase in Aged Population

The aging population and the resulting increase in home healthcare will benefit the DME business. You must make sure that the proper checks and balances are in place to assist you in determining eligibility, obtaining timely authorizations, and informing the physician’s office about the full process before initiating treatment. As a result, managing prior authorization for DME necessitates the expert assistance of a reputable medical billing partner.

Significant need for a strong DME prior authorization system

You require the assurance of a revenue cycle management partner who will streamline the entire process for you. One of the top priorities will be to cut in-house billing costs. Your medical billing service provider should offer you with a clear procedure for prior approvals to help you prevent practice management mistakes.

A rigorous awareness of payer priorities will be required to make your DME prior authorization procedure work. Your partner should be able to assist you in being deliberate and swift in reducing chance variables, which ultimately elevates your DME practice’s total denial management efforts.

The need of the Hour

Strongest processes and skilled resources will assist you in receiving rapid DME prior authorization and verification. Driving your care management services will undoubtedly be determined by how well you improve your payables in the long run. A complete prior authorization provides impetus and aids in the reduction of pending accounts receivable, which impedes reimbursements.

Finding a high-quality medical billing service that can function as a seamless extension of your current operations will be an excellent value proposition. Receiving prior authorizations on time is critical to providing timely and effective patient treatment.

Key Takeaways

The medical billing company should be able to present a comprehensive explanation of how they would alleviate your existing practice management issues and assist you in DME prior authorizations and more reimbursements through effective business checks. While it will let your in-house staff to devote more time to care management activities, you will also save money by working with dedicated resources who are experts in DME billing.