Durable Medical Equipment Operations and Management-Video: Denial Management

Video Transcription

Video Summary

Nick Hopper, Director of Commercial Operations for Novus Healthcare Solutions, discusses denial management in DME programs. Denials happen when payers deem prescribed DME products medically unnecessary, leading to coverage refusal. Common denial causes include product specifics, HCPCS codes, payer restrictions, and claim errors. To minimize denials, Hopper emphasizes verifying patient information, securing prior authorizations, and ensuring accurate documentation and coding. An established appeals process is crucial; timely appeals with complete documentation can mitigate denials. Strategies for appeal success involve submissions within payer timelines and including necessary information such as updated HCPCS codes and authorization numbers. To avoid denials and improve revenue cycle management, practices should educate staff on payer requirements, utilize technology for process optimization, and ensure providers understand medical criteria for DME prescriptions. Proactive management of DME denials is essential for maintaining revenue flow and optimizing business operations.

Keywords

denial management

DME programs

HCPCS codes

prior authorizations

appeals process

revenue cycle management