How deep DME billing expertise and structured workflows gave a fast-growing billing company room to expand
A rapidly expanding durable medical equipment (DME) billing company had ambitious plans to grow its revenue cycle management (RCM) services. Its in-house team and manual processes were under growing strain. The inefficiencies started to limit its ability to grow and weigh on profitability.
To support its growth goals, the company chose Access Healthcare as a strategic partner. Three things drew it to us: our deep DME billing expertise, a flexible workforce model, and advanced workflow technology. With more than 12 years of experience in the space, Access Healthcare brought the industry knowledge and operational flexibility to speed up the company's expansion.
Building a foundation for efficient growth
The partnership did more than add FTEs. It changed how the company's billing operation runs. Access Healthcare quickly hired and trained DME billing specialists and integrated them into the company's framework. We also deployed our proprietary workflow management system, which brings real-time insight, process automation, and workflows built for high-volume revenue cycle tasks.
The immediate impact:
Rapid onboarding: We trained and deployed a team of DME billing specialists so the company could take on more volume.
Streamlined workflows: Structured revenue cycle processes removed inefficiencies and reduced errors.
Staffing matched to demand: Our technology kept the company staffed for demand without adding load to its internal team.
Technology-driven efficiency: Real-time reporting and automated claims processing sped up results.
Tackling the roadblocks behind DME denials
DME billing carries well-known roadblocks, the kind of issues behind many denials and lost revenue. Access Healthcare addressed them at the source:
Coding and prior authorization: We trained billing specialists on coding standards and payer-specific policies to correct coding and prior authorization issues and improve accuracy.
Medical necessity: We focused on medical necessity documentation so submissions met payer requirements and helped avoid denials.
Verification: We introduced verification steps to prevent missing information and incomplete documentation.
Timely filing and COB: We put proactive management and tracking in place to support timely filing and coordination of benefits.
By removing these roadblocks at the root, Access Healthcare helped the company move toward faster reimbursements, fewer denials, and stronger cash flow, for the DME company and its own clients.
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 top reasons for DME claim denials
Lack of medical necessity
Incomplete documentation
Non-covered item
Missing information
Incorrect coding
Timely filing
Coordination of benefits (COB)
Prior authorization
Duplicate claims
Exceeding maximum benefit
Room to grow
Through this partnership, Access Healthcare helped move the company's operation from a manual, resource-limited model to one built on technology and structured workflows. With an expert workforce, automation, and streamlined processes, the company has the capacity to pursue its growth plans with fewer operational limits.
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