DME suppliers billing
DME suppliers billing,
without the denials.
Durable medical equipment claims depend on paperwork more than any other kind of billing: orders, medical necessity, delivery proof and rental months. We keep the file complete so the claim gets paid.
What makes it hard
Where dme suppliers revenue gets lost.
Orders and medical necessity
Each item needs a valid written order and documentation of medical necessity in the patient's record before the claim is filed.
Modifiers
HCPCS codes need the right modifiers: NU for new purchase, RR for rental, KX when coverage criteria are met, and others by item.
Rental cycles
Capped rental items are billed monthly for a set number of months, and a missed or duplicate month causes denials.
Prior authorization
Medicare and many plans require prior authorization for certain items such as power mobility devices and some orthoses.
Proof of delivery
Without signed proof of delivery, claims can be denied or recouped in an audit.
How we handle it
Checks built into every claim.
Our team and the GetMax platform apply these checks before claims go out, not after the denial comes back.
- Order and documentation checklists completed before billing
- Modifiers applied by item, payer and coverage criteria
- Rental months tracked per patient and item
- Prior authorization filed for items that need it
- Proof of delivery stored with the claim
Frequently asked
Questions we hear a lot.
What does the KX modifier mean on a DME claim?
It tells the payer that the coverage criteria for that item are met and the documentation is on file.
What is a capped rental?
An item Medicare pays for as a monthly rental for a set number of months, after which the patient owns it. Each rental month is billed separately.
Keep reading
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Chiropractic billing for Medicare and commercial plans: spinal manipulation codes, AT and GA modifiers, ABNs, documentation and visit limits handled.
Learn more →Let's look at your dme suppliers numbers.
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