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Healthcare providers in the Home Medical Equipment (HME) industry face a myriad of challenges when it comes to claims processing and reimbursement. Understanding and addressing common denial reasons is crucial for maintaining a healthy revenue cycle and ensuring operational efficiency. By analyzing data from over 1.2 million denials, our experts have identified the top 10 HME denial reasons, shedding light on common issues and strategies for prevention. These top 10 HME denials represent more than 50% of all denials. While the focus is often on the top 5 denial reasons, it's essential to shed light on the other 5 denials that providers encounter in their day-to-day operations.
1. Non-Covered Items (96 Denial): One of the common denials that providers face is related to non-covered items. This denial can be complex, especially in scenarios involving multiple insurance payers. Understanding the nuances of non-covered items and navigating the billing process effectively is key to mitigating this denial reason.
2. Attachment Requirements (252 Denial): Providers often encounter denials that require specific attachments, such as manufacturer invoices. Meeting attachment requirements is crucial for claim approval and reimbursement. Developing streamlined processes for gathering and submitting attachments can help providers overcome this common denial reason.
3. Coordination of Benefits (22 Denial): Issues related to coordination of benefits can lead to denials, particularly when there are discrepancies in insurance information. Providers must proactively verify and update patient insurance details to prevent coordination of benefits denials and ensure smooth claims processing.
4. Benefit Maximum Reached (119 Denial): Denials related to reaching benefit maximums, such as rental months exceeding limits, pose challenges for providers. Understanding benefit coverage and billing regulations is essential to avoid exceeding maximum limits and facing reimbursement issues.
5. Generic Denials (A1 Denial): Generic denials, often used as catchall reasons by commercial plans and Medicaid payers, require careful attention to remark codes for clarification. Providers must decode these generic denials to address underlying issues and resubmit claims with accurate information for successful processing.
The Top 5 HME Denials that Made the List
Navigating the complexities of HME billing and claims management requires a proactive approach and a deep understanding of denial reasons. By identifying common denials and implementing targeted strategies to address them, healthcare providers can streamline their revenue cycle, minimize revenue loss, and enhance overall operational efficiency.
Join Prochant's Joey Graham, Chief Revenue Officer, and MiraVista's Andrea Stark for an insightful discussion focused on denial management. They will share the latest trends, best practices, and practical strategies for successful denial management, leveraging their deep experience in revenue cycle management.
Don't miss this exceptional opportunity to gain valuable insights from two of the industry's leading experts.
Stay Ahead of the Curve
Understand the evolving landscape of denial management, including regulatory changes and technological advancements such as Al, to keep your business compliant and competitive.
Gain Expert Insights
Absorb the latest in denial management best practices from industry leaders and learn how to effectively apply these strategies to reduce losses and enhance revenue.
Real-World Use Cases
Explore practical, actionable strategies and tools through real-world examples that can be immediately leveraged to overhaul your denial processes, significantly improving both efficiency and success rates.
To watch the webinar on demand, fill out the form here.
Prochant is the only AI-driven reimbursement service provider in the home-based care industry. We deliver focused revenue cycle management (RCM) solutions to healthcare providers with 7 wholly-owned global delivery centers. Our expertise lies in providing end-to-end RCM for home-based care, infusion, and specialty pharmacies, consistently delivering exceptional results to some of the leading healthcare providers in the country. We harness specialized automation technology and deep industry knowledge to streamline the time-consuming and expensive reimbursement process. As a result, we help healthcare providers accelerate their collections, increase revenue, and reduce operational costs while managing risk. Prochant is HITRUST certified, the gold standard for HIPAA security.