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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Challenges and Opportunities of Durable Medical Equipment Practice (DME)

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The necessity of Durable Medical Equipments (DMEs) had never been so high – in the U.S. 30% to 54% of those over 65 years have some form of disability; around 75% to 90% of such disabled require some form of DME to keep them mobile or enabled.  It is also estimated that around 1.5 million people are currently in need of wheelchairs and braces. And, when you add the population that is likely to be in need of other forms of durable medical equipment – prosthetics, orthotics, and supplies (DMEPOS) – it will be some opportunity for people involved in Durable Medical Equipment Practice Services: physicians, pharmacies, and manufacturers/suppliers. But, because DME services are physician-recommended, we are more interested in how physicians themselves can recommend, source, and administer DMEs.

While physicians can benefit immensely from an integrated DME management, there are challenges on the way – being equipped with a Medicare-enrolled and recognized pharmacy, sourcing supplies from bidders authorized by CMS, and showing up as participating suppliers, who accept Medicare-approved fees on DMEs.

Physicians who are willing to have pharmacies attached with Medicare Part B approval need to have full-fledged Medicare Part B recognized DME supplies.  The importance of having Medicare-approved DMEs at your pharmacy is that it enables patients to have access to DMEs that are fully covered and reimbursed from Medicare Part B.

DMEs cannot be freely traded at your pharmacy; you need to apply for authorization from CMS. First, you need to apply by filling up Form CMS-855S for all likely suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). Applications are verified by National Supplier Clearinghouse (NSC) before being certified for compliance with DMEPOS Supplier Standards, as set forth in 42 CFR 424.57

Browse All: DME Medical Billing

Physicians in DME services are expected to be responsible – being responsible means agreeing to accept Medicare-approved amounts as full payment. Physicians that accept this clause will stand to collect only 20% of the approved amount after the patient has paid the part B deductible. Though not mandatory, being a partner in sharing monetary responsibility may have disguised benefits, such as goodwill and patient-initiated referrals.

To learn more about The Challenges and Opportunities of Durable Medical Equipment Practice (DME), click here: https://bit.ly/3WnOlwE Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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