Manual claims processing can be a costly, time-consuming process marred by potential errors. This is especially true for Durable Medical Equipment (DME) 10-month rentals, which are a complex but crucial part of patient care. Physicians order equipment that provides therapeutic benefits to the patient, and these rentals cover a period of 10 continuous months, at which point they are considered paid up to the purchase price.
The Challenge: Manual Claims Processing Struggles
For a SymKey client, this common 10-month DME workflow consuming 2.5 Full Time Equivalents (FTEs) and an average of 6 hours for a total of 15 hours.
SymKey Automation
Run query filters to identify the DME Universe
Claim must be in Pending or Approved status
Claim must belong to current accounting cycle
Accounting cycle has to be 'OPEN"
Claim line modifier must equal "RR"
Do not include Daily Rentals (E0618 and E0619)
Validate unit/quanity
If quantity is 1, don't include procedure codes E0202, E0935, E2365 and E2366
Has member had 10 prior positive responsibility for same procedure and diagnosis? If yes, include in universe.
Kickoff SymKey actions on each DME line identified as having fulfilled its 10-month member responsibility
If copay is greater than 0, then change to 0
If deductible is greater than 0, then change to 0
If coinsurance is greater than 0, then change to 0
Add CARC and RARC code to the detail line
Add note to claim of "OVER 10 MONTH RENTAL, NO MEMBER RESPONSIBILITY APPLIES"
SymKey robots can automate this once manual process so examiners can focus on other tasks. The transformation goes beyond time saved; it’s increases the efficiency of the claims department while ensuring accuracy and avoid overpayments.
Ready to Unlock Efficiency?
Contact us today to learn how you can deploy your SymKey robots to automate this scenario based on your business needs. Our HCIM Support Team is here to guide you in using these robots to automate manual tasks and save you valuable time.