Are Primary Care Claim Denials Increasing Revenue Loss?

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Yes,  primary care claim denials are increasingly contributing to revenue loss for physician practices by delaying reimbursements, increasing administrative workload, and weakening overall revenue integrity. As payer scrutiny intensifies and documentation requirements expand, primary care practices across the country are seeing a measurable rise in denial rates that directly affect operational stability and financial outcomes. Primary care providers operate on high patient volumes and relatively thin margins. When denials increase—even slightly—the cumulative impact can significantly reduce collections and ultimately affect a practice’s ability to yield EBITDA . Understanding why these denials occur and how to prevent them is essential for maintaining a healthy revenue cycle. The Growing Impact of Primary Care Claim Denials In recent years, payers have strengthened claim review processes, automated adjudication systems, and documentation requirements. These changes have led to...
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Know your DME HCPCS Codes

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In DME medical billing, your DME coders require correct HCPCS codes along with correct modifiers that are used for providing more details about the equipment. If your medical coders are unable to use modifiers or not using them in the correct manner, then the claims may get denied by the insurance company. Some common DME modifiers include RR- rental, UE- purchase of used equipment, and NU- purchase of new equipment.

When a laboratory demand, request for DME is being filled, medical coders will be needed for ICD-10 codes for a patient’s diagnosis.

To use an appropriate HCPCS code for the DME item, many HCPCS codes need a modifier. Modifiers are used to provide more details about the DME item. e.g. The modifier might indicate to HMSA that an item is new, rented on a capped basis, or rented. For capped rentals, modifiers differentiate which month’s rental is being billed.

If your billers use these modifiers incorrectly then the claim will be rejected. To speed up this process of your claims, show the first-month rental by adding the appropriate modifier code and bill your claims in successive order. 


To get more information about DME HCPCS Codes click here: https://bit.ly/3rLoDUp. Get in touch with us at: info@medicalbillersandcoders.com/ 888-357-3226. 

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