No medical supply ever publicizes their billing numbers; however, I want to let everyone know what the team at Howard’s is up to. According to CMS standards, on the first round of audits for Medicare, the average durable medical supply has 85% of their claims denied by Medicare when they are audited. Now, there are four rounds of appeals, so even though this means only 15% of claims are paid on average in the first round of appeals, it gives you an idea the number of claims Medicare denies that comes across their books.
Last week, Howard’s Medical received our numbers for the last forty-five days. We are running at a 25% denial rate for our Medicare claims, a full 60% better than industry average!
How do we do it?
- We communicate with your providers and know the rules for billing equipment inside and out in regards to medical supplies. Just as you want your accountant to know the tax rules inside and out, we know medical supply rules inside and out.
- We have an amazing team. They take the time to verify your eligibility, work with you when you are in the store, ask the right questions so when we bill your claims everything goes through and it gets paid.
- We also know when an item is not going to be covered. For example when a patient is in a nursing home or hospice, Medicare does not cover most medical equipment.
One other question you might wonder, a 25% denial rate still seems high. You are right, it is. A few other thoughts on this:
- There are multiple rounds on the appeals processes when we bill claims. The 75% success rate for Howard’s is just for round one. If we have one of your claims and we fail in round one, we look to see why we failed, verify the reason and sometimes it is a very simple reprocessing of the claim. Other times we have to contact your provider and ask for addendums to chart notes. Worst case scenarios we do have to pick up equipment.
- Other insurances for the most part are significantly easier to bill than Medicare. So if you don’t have Medicare take heart, life is much easier for the billing side of things for your medical supply company.
- Medicare is slowly working on things. There are a number of bills in congress working to streamline things. Please contact your senator and congressperson and ask them to ease up on the audits. We are not anti-audits because they prevent fraud but in high school if you get 99 out of 100 on a test this is an A+. With a Medicare audit, a 99 out a 100 is a failure that has to be fixed!
If you have any durable medical or respiratory billing questions, give the team at Howard’s a call, we really do know what we are talking about and have the numbers to back it up: 509-654-9899.