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by Ronnie Hastings
The demographic trends ahead in the DME industry are encouraging. The preferences for convenience among patients are increasing with time. The consumers of medical service now are more proactive than ever before. Personalization is the buzzword today and it is precisely for this reason preference for home healthcare is on the rise.
The DME market is also favored by the increase in the number of insured population. The aging population number is also on the rise. The use of durable medical equipment is also rising sharply with the use of new technology that is making it all the more desirable. Even if we take into account the present complexities in the federal environment, the DME market is expected to grow in the next five years and reach $60 billion. The CAGR will be around 5.3% and the opportunities for investment will be lucrative.
Surging costs in prior authorization: A worry area in DME claims
The Master List of 135 items that has already been flagged for unnecessary utilization is subject to a comprehensive process of prior authorization. Ideally, the DMEPOS items will stay same for the next 10 years unless it is removed while prices fall under the payment threshold.
The CMS anticipates that costs will be worth $150 million with prior authorization till 2025. The prior auth costs annually stand at a whopping $31 billion. In fact, transparency of provider service prices and repeal of ACA implies that DME providers will have to focus more on effective revenue cycle management. Understanding the claims adjudication mandates and quality denial management metrics will be a top priority.
A top class medical billing partner that specializes in handling DME billing by employing the right checks and balances will be hugely beneficial. Consistency in practice management efforts should be a top priority that will ultimately lay down a strong foundation for improved reimbursements.
Prominent Healthcare Revenue Cycle Management Company that builds you financial credibility
DME providers will need an actionable plan from a quality medical billing company that provides end to end revenue cycle management support. Many providers face challenges by lacking the proficiency in handling multiple billing platforms. Efficient resources that understand the directives of the payers in respect to claims adjudication are going to be important.
The company should be able to reduce billing costs, improve collections by implementing excellent account management techniques and finally increase payables with consistency. A quality company that works as a perfect operational extension and seamlessly associates itself will be laying down a string roadmap.
Bio: Ronnie Hastings is an experienced professional and is an expert in major operational and business development responsibilities related to medical billing and revenue cycle management. He is also a prolific writer and discusses major trends across US healthcare industry.