High-performing billing partners provide expert DME billing for DMEPOS suppliers — HCPCS coding, Medicare DMEPOS compliance, prior authorization management, PDAC documentation, and full AR follow-up. Performance-based billing that keeps your cash flow healthy and your audit risk low.
DME billing (durable medical equipment billing) is the process of submitting claims to Medicare, Medicaid, and commercial insurance for medical equipment provided to patients — including wheelchairs, CPAP/BiPAP devices, hospital beds, prosthetics, orthotics, and diabetic supplies. DME billing uses HCPCS Level II codes and requires strict documentation including physician orders, certificates of medical necessity, and proof of delivery. Medicare DME billing is one of the most heavily audited claim types in healthcare — improper documentation is the #1 audit trigger.
Correct HCPCS Level II code selection based on equipment features, modifiers (KX, GA, GY), and payer-specific requirements. PDAC coding verification to ensure maximum allowable reimbursement under the correct code.
Medicare DMEPOS fee schedule billing, competitive bidding program compliance, advance beneficiary notice (ABN) management, and LCD/NCD medical necessity requirement tracking.
Prior auth submission and tracking for all payers. Medicare Prior Authorization Program (PAP) management. Proactive renewal tracking for ongoing equipment and supplies.
Certificate of medical necessity (CMN) preparation and physician follow-up. Detailed written order (DWO) compliance review. Proof of delivery documentation management.
Pre-billing documentation audit to reduce audit risk. ADR (additional documentation request) response preparation. Audit appeal management with clinical documentation support.
Automated billing cycles for recurring supplies (CPAP supplies, diabetic testing supplies, incontinence products). Frequency limit tracking to prevent overbilling and underbilling.
Deep knowledge of PDAC coding decisions, Medicare DMEPOS fee schedules, competitive bidding program rules, and LCD/NCD documentation requirements — the most complex billing environment in healthcare.
Every claim leaves our team with a complete documentation file — CMN, DWO, proof of delivery, clinical notes. Pre-billing audit check reduces ADR risk before the claim ever goes out.
We handle the entire prior auth workflow — submission, tracking, appeals, and renewal — so no equipment ships without confirmed authorization and no revenue is lost to expired auths.
Look for percentage-of-collections pricing. It ties the billing partner's revenue to yours — they stay motivated to fight every denial and appeal every underpayment.
We'll review your HCPCS coding accuracy, documentation completeness, denial patterns, and audit risk exposure — and show you how much revenue you're leaving on the table.