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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ICD-10 and DME Billing- Does Outsourcing Spell More Revenue?

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icd10anddmebillingdoesoutsourcingspellmorerevenue.jpg

ICD-10 and DME Billing

DME billing is the process of submitting and receiving payment for a claim from the insurance company. Implementing, maintaining, and educating staff on proper billing is vital to a DME provider’s success. The challenges facing Durable Medical Equipment (DME) organizations with the upcoming ICD-10 coding system are plenty. Although the DME you bill for will still employ the same HCPCS codes, the actual difference will be in the diagnosis coding itself.

  • Firstly, the transition from ICD-9 to the new ICD-10 coding system has led to an increase in the number of codes for procedures from 3,824 to 71,924 and simultaneously has also increased the number of codes for diagnosis from 14,025 to 69,823.
  • Secondly, there are few one-to-one, cross-walked codes in the ICD-10
  • Thirdly, it is a known fact that the DME providers receive meager information from the physician to convert the codes accurately thus leading to delays in claims causing a shortage in cash flow.
  • Fourthly, reimbursement of DME incidents needs to establish the necessity of a DME device within a treatment episode and the knowledge of the device that covers it. More accurate identification of the treatment episode that makes the use of the device eligible for reimbursement is now more than ever required

Fifthly, software updates are required, and the capital investment will increase given the training of the staff. Moreover, the labor-intensive work like handling dual code sets much after the October 1 2015 deadline until all is ironed out, the change in business documents like contracts, bills, training and operation documents, etc. associated with ICD-9 codes will all need to be updated.

To know more about the ICD-10 and DME Billing- Does Outsourcing Spell More Revenue?, click here: https://bit.ly/3HCMeij Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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