Specialty billing / Durable Medical Equipment (DME)
DME is a documentation business that happens to ship products. The claim itself is short. What determines payment is the file behind it: a compliant order, a face-to-face encounter note, proof of delivery, and evidence that the item meets the coverage criteria in the applicable policy. Suppliers lose money on files, not on codes.
0
Years in revenue cycle
48h
Claim filing window
30d
Target days to payment
HIPAA
Compliant by design
Where it breaks
An order missing the beneficiary name, item description, quantity, ordering practitioner NPI, or a valid signature and date is not fixable after the audit request arrives. The claim is recouped even when the equipment was clearly needed.
Capped rental items follow a fixed month count with modifiers that change over the cycle, and continuous use has to be confirmed. Billing past the cap or restarting a cycle after a break in service creates overpayments that resurface months later.
Coverage policies require specific clinical findings, and the treating practitioner's chart, not the supplier's, has to contain them. Suppliers who deliver before obtaining the chart notes discover the gap only when the payer requests records.
Delivery documentation needs the beneficiary or designee signature, the delivery date, and a description matching the billed item. Shipping confirmations without an itemized description are routinely rejected in post-payment review.
Frequently billed
Representative codes only. Actual coding follows current CPT/HCPCS guidance and payer policy.
Denials we prevent
FAQ
The beneficiary's name, a description of the item, the quantity if applicable, the order date, the treating practitioner's name and NPI, and the practitioner's signature. For items requiring it, the order must be received before delivery. An order missing any element cannot be corrected retroactively once a review begins.
Certain equipment is rented for a defined number of months, after which title generally transfers to the beneficiary and no further rental is payable. Each rental month carries a modifier indicating its position in the sequence. Tracking the cycle per beneficiary, including breaks in service, is what prevents overpayment recoupment.
Because coverage is decided on documentation, not on obvious need. If the treating practitioner's chart does not contain the specific findings the policy names, the reviewer has nothing to approve. Obtaining chart notes before delivery, rather than after a records request, is the single highest-value habit for a DME supplier.
The beneficiary or an authorized designee must sign, the delivery date must be recorded, and the document must describe the specific items delivered including quantity. When a shipping service is used, the record must tie the tracking information to an itemized list. A generic delivery confirmation is not sufficient on its own.
Yes. We review the requested files against the applicable coverage policy, identify which elements are present and which are genuinely missing, and assemble the response with supporting documentation organized the way reviewers read it. Where records were incorrectly judged deficient, we prepare the appeal at the appropriate level.
Other specialties
Next step
Send us your specialty, claim volume and current billing setup. We will come back with a proposal you can act on.
