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How one DME supplier took on the challenge of same or similar denials

For durable medical equipment (DME) suppliers, navigating billing and reimbursement can be time-consuming and resource intensive. Medicare reimbursement rules present particular challenges, especially when it comes to checking for same or similar items. Same or similar denials happen when suppliers submit a claim for an item that a Medicare beneficiary already rents or owns that is still within its reasonable and useful timeline, usually about five years.

Checking HCPCS codes for same or similar items has always been a time-intensive, manual process. But suppliers who aren’t checking all HCPCS codes for same or similar are at risk of denials and write-offs — ultimately incurring costs and affecting cash flow.

Historically, there has not been an automated method to check patients’ billing history for same or similar items, so suppliers’ only options have been:

  • Checking a MAC portal for claim history
  • Checking the VPIQ system for CMN status
  • Calling Medicare support
  • Asking the patient

Fortunately, there are now ways for DME suppliers to tackle the problem without wasting resources. A DME Same or Similar solution like Waystar’s can drastically reduce denial rates, improve cash flow and automate the process of checking HCPCS codes for same or similar items. We chatted with Sean Becker, AdaptHealth’s VP of Integrations & Conversions, to explore how they automated their same or similar verification process.

AdaptHealth is a national network of full-service medical equipment companies that offer products and services for patients out of the hospital and in their homes.

Waystar: How were you handling the same or similar process prior to Waystar?

AdaptHealth: “We used to go to MAC portals to verify items, then hand-typed them into a spreadsheet that we tracked by jurisdiction — obviously, a very manual process. We no longer require a team doing the verification out of the MAC portal and with a manual upload. We were also running a same or similar verification query through a data warehouse looking at future service dates. Now, with an have an automated system, we can look two weeks out.”

Waystar: How has this new tool improved your cash flow?

AdaptHealth: “Not only did we decrease our workload by five or six full-time equivalents (FTEs), the accuracy of the data has gotten much better. Our volume went up significantly this year, and using Same or Similar Batch, we’ve lessened our normal denial rate by 15%.

“The monetary value of same or similar denials is enough that the senior leadership of our company has pushed to reduce them as much as possible. From perspective of revenue to denials, same or similar denials represent a small percentage. However, from a quantity standpoint, it’s one of our highest denial reasons. To sum it up, the tool is helping with labor reduction, denial reduction, and accuracy of data, all of which helps cash flow.”

Waystar: What improvements did you see this year, especially amid the COVID-19 pandemic?

AdaptHealth: “When COVID first hit, we used a lot of manual labor overseas. Overnight, that whole group was unable to work and couldn’t access WiFi from home, which lasted 45 days. We looked to Waystar to automate our processes immediately, and in doing so, Waystar’s tool gave us the ability to work on denial reduction. That level of automation kept more cash in our pocket.”

Waystar: What else would you say to other DME companies about your new workflows?

AdaptHealth: “A lot of companies have a high frequency of orders—and it’s just not ideal to have a staff team manually checking for same or similar items in the MAC portals. If you look at these verifications proactively, you’re essentially getting patients back on the right schedule so you’re not dispensing products too soon. In turn, you don’t have to worry about billing an order just to get a denial. The [Same or Similar] tool will save you a bunch of labor and, ultimately, save you denials and increase cash flow.”

The wrap up

The complexities of managing Medicare claims can create numerous challenges for billing teams of any size. But an intuitive, automated solution can make all the difference. With Waystar, AdaptHealth was able to free up time for their team while driving revenue growth.

Our Same or Similar offering is a versatile solution for any supplier looking to reduce denials and simplify a crucial step in the process of managing their Medicare claims.

Learn more about durable medical equipment solutions from Waystar.

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