Best US-based DME Billing Service Provider
As a top DME billing service provider in the USA, we are well aware of the struggles Durable Medical Equipment suppliers go through during the billing process. From constant denials and reduced reimbursements to Medicare takebacks, prior authorization delays, staff burnout, and many more — DME billing can be hard to manage.
Our professional outsourced DME billing team copes with such challenges with expertise. Having years of industry-related experience helps us successfully manage your complete DME billing process accurately. So, outsource your billing to a trusted third-party DME billing service provider.
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DME BILLING SERVICE
DME suppliers often face the same billing challenges repeatedly. Examples include denied claims, delayed payment, and staff re-working billing records due to additional documentation requested from a payer, or an invoice that does not match the equipment that was shipped to the patient. These billing issues impact the timely availability of cash flow in the DMEPOS business, which can also make it difficult for the business to obtain reimbursement from Medicare, Medicaid, or commercial insurance plans.
DME Billing Service supports a DME supplier’s billing side by managing the full billing cycle for durable medical equipment. This includes verifying coverage and eligibility with the patients’ insurance carrier, collecting and assembling all necessary documentation, using the correct coding and modifiers, submitting claims to payers, tracking claims, posting payments, and managing denial, correction, and appeal processes as necessary.
As a result of using a DME Billing Service, the operational or business aspects of a DME/HME company (such as ordering, delivering, processing paperwork, and conducting follow-up on the patient) are not impacted by billing-related issues. Consequently, DME Businesses stay profitable and vendors receive timely and complete reimbursement for orthotics, prosthetics, and wheelchairs.
What’s Included In This DME Billing Service?
Collecting Patient and Insurance Data
At the beginning, all relevant data about the patient and his/her insurance will be collected. Then, a check is performed regarding the eligibility of the patient for benefits under his/her plan, to verify that the DME/HME benefit is covered by this plan, and to see if prior approval is needed from the payer.
Organizing Required Documentation
All necessary paperwork is organized, and documented as it relates to the specific item being delivered to the patient. In most cases, this will include the original prescription order, medical records (chart notes), a document verifying delivery of the item, and any forms required by the payer for processing of the DME and HME claims.
Preparing and Submitting Claims
The DME Billing Service Provider prepares each claim in the proper format, including the use of the correct HCPCS/CPT codes, to ensure that the claim accurately represents the item furnished to the patient. Once prepared, the claim gets electronically transmitted to the applicable payer via either direct transmission to the payer’s portal, or through a clearinghouse to the payer.
Resolving Rejections and Denials
If a claim comes back unpaid, the reason is reviewed first to determine why it was denied, and/or what additional information is required to resubmit the claim for payment consideration. Then the missing detail is added or the error is corrected, and the claim is resubmitted.
Posting Payments and Patient Balances
When payments are received from the payers, those payments will be entered into the billing system to record the amount of the payment made by the payer, and what balance remains due from the patient. Any differences, like deductibles, co-pays, co-insurance, and reductions applied by the payer, will also be entered into the system, to avoid confusion when calculating patient balances.
Monitoring Unpaid Claims and Providing Updates
Claims which remain unpaid/closed-out, or have no status update from the payor, will continue to be monitored until resolved. During the process, the DME Billing Company will provide periodic updates to the supplier, regarding the status of the claims; specifically, what was billed, what was paid, what was denied, and what is currently pending.
What’s Included In This DME Billing Service?
Collecting Patient and Insurance Data
At the beginning, all relevant data about the patient and his/her insurance will be collected. Then, a check is performed regarding the eligibility of the patient for benefits under his/her plan, to verify that the DME/HME benefit is covered by this plan, and to see if prior approval is needed from the payer.
Organizing Required Documentation
All necessary paperwork is organized, and documented as it relates to the specific item being delivered to the patient. In most cases, this will include the original prescription order, medical records (chart notes), a document verifying delivery of the item, and any forms required by the payer for processing of the DME and HME claims.
Preparing and Submitting Claims
The DME Billing Service Provider prepares each claim in the proper format, including the use of the correct HCPCS/CPT codes, to ensure that the claim accurately represents the item furnished to the patient. Once prepared, the claim gets electronically transmitted to the applicable payer via either direct transmission to the payer’s portal, or through a clearinghouse to the payer.
Resolving Rejections and Denials
If a claim comes back unpaid, the reason is reviewed first to determine why it was denied, and/or what additional information is required to resubmit the claim for payment consideration. Then the missing detail is added or the error is corrected, and the claim is resubmitted.
Posting Payments and Patient Balances
When payments are received from the payers, those payments will be entered into the billing system to record the amount of the payment made by the payer, and what balance remains due from the patient. Any differences, like deductibles, co-pays, co-insurance, and reductions applied by the payer, will also be entered into the system, to avoid confusion when calculating patient balances.
Monitoring Unpaid Claims and Providing Updates
Claims which remain unpaid/closed-out, or have no status update from the payor, will continue to be monitored until resolved. During the process, the DME Billing Company will provide periodic updates to the supplier, regarding the status of the claims; specifically, what was billed, what was paid, what was denied, and what is currently pending.
How DME Billing Service Works ?
A DMEPOS Vendor may have delivered all the necessary equipment, but there is a lot of other work needed for the vendor to be paid for those deliveries. The vendor will send the DME Billing Company the basic information about the order: patient information, insurance information, delivery date, what item was provided, and the documentation supporting the medical necessity of the order. As soon as the DME Billing Service Provider receives the information from the vendor, they begin the billing process from eligibility to reimbursement.
Step #1. Eligibility is verified before billing
Prior to submitting claims on behalf of the vendor, the DME Billing Company verifies whether the patient’s insurance is active and if the DME benefit is available for the specific item(s) being billed.
If there is any issue with the claim due to missing data (i.e., missing prescription, medical records, etc.), the billing company identifies the issue, requests the missing information from the respective party, and holds the claim until it is complete, thereby preventing the claim from getting denied at a later time.
Step #2. Claims are prepared and sent to the payer
The DME biller prepares the claim, for the medical equipment supplied, using the correct item code and billing modifiers.
For example, a standard manual wheelchair is billed as K0001.
If the wheelchair is purchased, NU modifier is used. If it is a capped rental, the rental month is indicated in the claim by using modifier KH for month 1, KI for months 2-3, and KJ for months 4-13.
The biller then submits the claim electronically or via payer portal to the payer.
Step #3. Claim status is tracked and followed-up on
After the claim is submitted to the payer, the DME/HME billing team tracks the status of the claim until the payer responds.
There are three possible responses from the payer:
- Paid: The claim is processed for payment.
- Denied: The claim is rejected due to insufficient information or lack of medical necessity, etc.
- More Information Required: Payer needs more information to process the claim.
Whatever the payer is requesting, it’s the responsibility of the DME billing service provider to fulfill the payer’s requests and follow-up until the claim progresses to the next step toward payment.
Step #4. Denials are corrected and resubmitted
When a claim is rejected/denied, DME Billing Services Team reviews the rejection/denial reason and makes corrections, when applicable, and resubmits the claim. The DME medical biller creates an appeal packet using all relevant documents to support the claim, such as:
- Physician Order or Prescription
- Clinical Documentation to Support Medical Necessity
- Proof of Delivery
Step #5. Payment posting and updates are communicated
Upon receipt of payment from the payer, the billing service provider posts the payment to show transparency of the payment history, which includes:
- What the payer paid
- Any adjustments to the payment
- What remains outstanding
Additionally, if the payer requires the patient to be responsible for any portion of the cost (e.g., deductible or coinsurance), this is clearly reflected on the account.
Any claims that need further action (i.e., a correction, a document request, an appeal, etc.) are handled by the DME Medical Billing Service until the claim is closed.
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Built-in RCM Features for DMEPOS Suppliers
Some of the common challenges faced by durable medical equipment suppliers when it comes to their billing are:
- Delivered items that do not generate a payment
- Rental months that do not get paid on time
- Uncollectible patient cost-share amounts
- Payments for delivered items that are less than expected (with no apparent explanation)
DME Billing Service has built-in RCM (Revenue Cycle Management) features designed to protect the reimbursement of DMEPOS items and make all available dollars easy to identify and work on.
Reimbursement Forecasting
Expected payment amounts for each delivered item or rental period are tracked so the supplier may view what was expected to be reimbursed by Medicare or other payers as opposed to what they have actually received.
Rental Revenue Tracking
Rental income is tracked monthly for the DMEPOS provider so the vendor will not lose money due to missed rental periods, incorrect billing for rental months, or rentals that stop paying without notice.
Resupply Scheduling
Items such as CPAP supplies and diabetic supplies that are typically reordered on a recurring basis are tracked relative to their reorder timing based upon payer guidelines so that the DMEPOS vendor will not lose resupply revenue due to missed reorder cycles or over-billing the payer.
Balance Recovery
Any differential between what is expected to be reimbursed and what is received as a payer payment is identified and reviewed to facilitate recovery of the funds due. Also, unpaid balances are sorted by the length of time they have existed so that the oldest balances are worked first and revenue generated by DME deliveries are not lost simply because they have been outstanding for a longer period of time.
Delivery is done but payment still not received?
Medicare (or another insurance provider) will only pay for a medical assistive equipment once they are confident it has been delivered AND once the proper paperwork supporting that delivery has been submitted.
Therefore, even if a DMEPOS product is delivered to a patient, Medicare will NOT automatically send out the reimbursement simply based upon that delivery alone. Medicare will only make payment once it is satisfied that the documentation provided as part of the paperwork bundle for that specific product order, meets their requirements as outlined below:
The submission packet must be “clear”, “complete” and “match” the “invoice”.
Some examples of how a simple discrepancy in paperwork can result in denied claims include:
The invoice indicates a “standard wheelchair K0001,” but the “delivery slip” only indicates “wheelchair,” without model number or K-code.
The “signed delivery date” indicated on the delivery slip differs from the “date of delivery” indicated on the invoice.
And honestly, such mistakes happen all the time when the front desk is juggling calls, deliveries, and processing paperwork simultaneously. A single discrepancy in the claim file may cause Medicare to deny the claim, and therefore, the supplier will have to absorb the costs associated with holding inventory and delivering the product, until payment is made.
DME Billing Services Company assists you by reviewing your DME delivery documentation prior to submitting your claim for payment, fixing missing information, and ensuring that the documentation included in the supporting dossier supporting the delivery of the product clearly aligns with the product that is being billed for, thereby reducing the likelihood of payment delays occurring after delivery.
Resupply Ships But The Revenue Is Not There
Many HME suppliers are losing money through resupply. Resupply includes items such as CPAP mask cushions, filter replacements, tubing, CPAP headgear, and replacement parts to a humidifier chamber which all have the potential of being denied when the payer denies the request due to lack of documentation showing that the refill request was made prior to shipping and during the payers’ acceptable time frame to receive a refill of the item.
Outsourced DME billing team will protect this revenue from resupply by documenting all shipments and creating a simple refill trail for all resupply shipments that were sent. For instance, before a CPAP cushion is shipped; a refill request is documented on the shipment record including the date and specific item(s) being refilled. This documentation would prevent the payer from denying the payment request at a future date since the documentation exists and the revenue will not be lost once the supplies have been shipped.
The Patient Needs The Item But The Payer Denies It
This happens when there is a duplicate item listed in the payer’s records (the payer’s computer thinks the patient already has this item). Many times the payers will block payment based on an “already provided” and/or “replacement too soon” status.
DME Billing Company catches the potential risks early in the process and responds as expected by the payer. DME biller also develops a plan quickly to assist with recovery of reimbursement should a denial occur including the original physicians order, physician explanation of necessity for a new/replacement item, proof of delivery etc… allowing the supplier to try and get reimbursement rather than absorb the loss.
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Our US-based best rated DME billing services provides complete billing support to healthcare practices guaranteeing full compensation of the services provided, reduction in claim denials and accurate claim submission.
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In-House vs Outsourced DME Billing
In-house medical billing may work for DME suppliers as long as the DMEPOS/HME Supplier has sufficient time, money, and management resources to create a billing department from scratch.
This includes hiring and maintaining experienced billers, training employees on Medicare and payer rule changes, providing coverage for vacations and employee turnover, and consistently pursuing payments.
The moment any of these items fall through the cracks, a predictable series of events occurs rapidly in in-house billing:
Reimbursement takes longer, denials rise, accounts receivable grows, and owners have to waste their time in payer portals, which keeps them away from running the equipment business.
IN-HOUSE BILLING
Outsourced DME Billing typically wins because it transforms the billing function into a specialized department function instead of a “best effort” task competing against all other tasks such as deliveries, intake, repairs, and customer calls.
A DME Billing Company operates exclusively within the revenue cycle and processes claims across all payers, including Medicare, Medicaid, and commercial payers. This type of expertise is critical in DME, where even minor detail differences determine whether payment will be made at all. Examples include: Is documentation ready? Are rental months accurate? Is resupply timing correct? Does the supplier comply with each individual payer’s requirements?
Additionally, when a DME Supplier outsources its billing functions, the primary operational risk associated with in-house billing – the risk of dependence upon one or two employees to protect cash flow – is eliminated.
OUTSOURCE BILLING
DME Billing Services In The USA
What changes when a DME supplier outsources their billing?
If a DME supplier’s objective is to have reliable reimbursement while focusing on supplying equipment, outsourcing their DME medical billing is usually the cleanest and safest option versus attempting to build and maintain a full in-house billing operation.
- Staffing risks are removed: no need to hire, train, manage turnover, etc. – “billing stops when someone leaves” is eliminated.
- Cash flow becomes more predictable: follow-up happens daily vs. “when there is time,” and therefore unpaid balances do not quietly age.
- Fewer preventable errors occur: experienced DME billers identify issues prior to payment that trigger denial/underpayment, particularly regarding Medicare and DMEPOS rules.
- Owners get clearer visibility into their financial position: billed/paid/pending/unpaid revenue is easier to track and act upon.
- Operations remain protected: the DME supplier’s team remains focused on intake/delivery/repair/resupply/customer service while billing continues in the background.
Trusted By Providers Nationwide
Managing DME billing in-house was becoming a real challenge for me. This team stepped in with a structured and compliant approach, like a life saver for my practice. Their attention to detail and understanding of DME workflows helped us improve cash flow and reduce administrative workload. Highly recommended for U.S.-based providers.
Dr. James Carter
Working with Zach has proven to be a game-changer for our practice. From eligibility checks to follow-ups, everything is handled efficiently and accurately. I’ve seen faster payments and far fewer denials, which has allowed me to prioritize patient care.
Dr. Sarah Thompson
Me and my practice has struggled with delayed payments and frequent claim denials before partnering with this DME billing team. Their knowledge of Medicare and payer requirements made an immediate difference. Our reimbursements improved significantly, and their communication has been clear and reliable throughout. Impressed…
