Successful DME compliance requires effort not just on your part, but on the part of your patients and insurance providers. Mistakes made can result in financial or legal consequences for your orthopaedic practice, or worse, a patient not getting the care they need. 

To help you avoid any missteps, we’ll share the top three most common DME compliance issues, and how to avoid them.

1. Errors: Paperwork mistakes result in claim denials or recoupments.

A large component of DME compliance is ensuring the paperwork is properly filled out for insurance companies’ review. The simplest error can result in a denied claim. The following are especially common: 

  1. Claim submission errors (coding, modifiers, etc.)
  2. Lack of or missing prior authorization
  3. Encounter documentation does not meet Medical Necessity Criteria
  4. Improper or missing Physician Orders and Proof of Delivery Documentation

For example, someone in your practice may prescribe an orthotic device to a patient. However, you find you can’t bill the payor for that prescription because the documentation doesn’t meet Medical Necessity Criteria. This means that not only will the practice not be paid for the equipment but your patient cannot get the equipment they need. 

2. Lack of Dedicated Staff: Your practice is missing the DME compliance expertise and focus required to keep up with payor changes.

The Office of the Inspector General (OIG) from the Department of Health and Human Services (HHS) recommends that every DME supplier designate a DME compliance officer and committee. They oversee activities such as:

  • Making sure outside suppliers maintain compliance on their end
  • Developing a system to flag potential DME compliance issues
  • Determining how to go about resolving these issues
  • Monitor changing laws and regulations
  • Internally and externally auditing the company’s DME compliance systems to reflect payor changes

A dedicated DME officer shows the OIG-HHS that your practice is dedicated to maintaining compliance and that you take potential fraud very seriously. This makes your practice much less likely to come under federal scrutiny, and much less vulnerable to DME compliance mistakes.

The OIG-HHS does recognize, however, that smaller practices may not be able to afford a team—or single individual—whose sole job is maintaining compliance. Many practices simply add compliance-related activities to an existing employee’s list of responsibilities.

While this may seem like a cost-effective way to show the OIG-HHS that your practice cares about compliance, simply shoving compliance activities onto an employee who already has a full workload may come off as suspicious. It can certainly lead to more common, avoidable DME compliance issues.

3. Loss Of Revenue: DME compliance errors eat into your profits.

When done right, the DME component of your orthopaedic practice should be an additional revenue stream and make the patient care experience more streamlined. 

However, without hiring someone with extensive knowledge of both DME compliance and supply chain management, you risk making critical errors resulting in loss of revenue. In fact, many practices lacking in DME resources only collect on 50-60% of claims they send.

How to Avoid These Common DME Compliance Issues

The real solution for these errors is revolutionary, yet simple: a cost-effective DME compliance team that continually monitors your practice for compliance and helps to increase claims collections.

Get the technology you need to avoid paperwork errors and the experts to look out for your practice.

Select Ortho is a complete DME compliance and supply chain management service. Our proprietary software audits your current DME compliance system and makes recommendations to correct any paperwork errors before your practice suffers the consequences. 

Our company has been helping practices increase their profitability for over ten years with members of our staff having over thirty years of experience in DME compliance. We have the resources and the knowledge to not only keep up with compliance but also manage billing and follow-ups with insurance providers and inventory management.

What about your profitability? Is partnering with a full-service DME point-of-sale provider worth it?

Our clients have gone from collecting on only 50-60% of insurance claims to 97% or more. They also see two more patients per day, on average, with satisfied patients returning over and over. Other benefits include: 

  • A dedicated staff is available for compliance-related activities, without the need to hire someone full-time. 
  • Your current employees will be more efficient without extra tasks on their plate.
  • We manage your supply chain and help you choose the most cost-effective DME-compliant providers.
  • Access to your practice’s client portal where you can see real-time metrics and reports on the state of your program.

Avoiding DME compliance issues shouldn’t be hard. 

Protect your patients, your practice, and your profits with a top-of-the-line DME solution provider. Select Ortho provides a free financial and compliance report to help you see where your orthopaedic practice is making the simple mistakes, where you’re lacking in expertise, and where your program could be more profitable.

Get back to what matters most: taking care of your patients while knowing their needs (and your own) are taken care of.

GET A FREE COMPLIANCE AUDIT