Durable Medical Equipment (DME) can be vital for patients and expensive for payers. Utilization management of DME by payers is becoming increasingly common.
Being prepared for these challenges can make a life-altering difference for your patients and a big impact on your cash flow. Understanding the complex coverage determinations and medical necessity requirements developed by payers to reduce expenses is essential. Whether it's a lack of personnel, a poor understanding of the disease process or an inadequate grasp of the medical necessity criteria, properly managing the utilization review process for the spectrum of products offered by your company can be a weak link.
The Cadenza Health team has been reviewing requests for DME for many years now. We have garnered an understanding of the coverage and medical necessity criteria during this time. We have developed insight in the payer review process because we have reviewed thousands of requests for these entities.
Our experience includes basic requests for lower cost items but also includes daily reviews of advanced equipment such as prosthetics and power mobility devices.
Whether we perform daily consultative assistance or work to sharpen your appeals process, let us help your organization improve your DME approval rates.