DME Billing Services
DME claims fail on paperwork, not on price.
Durable medical equipment billing lives or dies on documentation — CMNs, proof of delivery, medical necessity, rental cycles and the right modifier on the right line. We handle all of it, and we defend it when the audit letter arrives.
Why DME Is Harder
A medical biller is not a DME biller
Physician claims are judged on coding. DME claims are judged on evidence — and payers audit that evidence long after they have already paid you.
Not coding errors — missing CMNs, a physician order that does not match the HCPCS code, or a proof of delivery nobody chased after the driver left.
Miss a month, bill past the cap, or apply the wrong rental modifier and the whole sequence unravels — usually discovered when the payer recoups.
A claim paid today can be reviewed years from now. If the supporting file is incomplete, that revenue gets clawed back with interest.
KX, GA, GY, GZ, RR, NU, UE — each one is an assertion about coverage and necessity. Applied casually, they become a compliance exposure.
Required for a growing list of items. Unchased authorisations mean equipment already delivered against a claim that will never pay.
Oxygen, CPAP, mobility and orthotics each carry their own coverage criteria, and Medicare LCDs change without much warning.
We build the documentation file before the claim goes out — so the audit, whenever it comes, is a formality.
Request Free AuditScope of Work
Everything from intake to audit defence
You focus on getting equipment to patients. We make sure the paperwork behind it is complete, compliant and paid.
Eligibility & DMEPOS Verification
Coverage, competitive bidding status, deductible and same-or-similar history checked before the item ships — not after the denial.
Prior Authorization Management
Submitted, tracked and escalated. We chase the payer until there is a decision in writing, and we tell you before delivery if it will not come through.
CMN & Documentation Review
Physician orders, certificates of medical necessity and chart notes reviewed against payer coverage criteria before submission — gaps flagged back to the referring provider.
Proof of Delivery Tracking
Signed PODs collected, matched to the claim and stored in the patient file. No claim leaves without its delivery evidence attached.
HCPCS Coding & Modifiers
Correct HCPCS selection with KX, GA, GY, GZ, RR, NU and UE applied deliberately — each one supported by what is actually in the file.
Rental Cycle & Cap Management
Every capped rental tracked month by month, with continued-use and continued-need documentation triggered on schedule so the sequence never breaks.
Claim Submission & Posting
Electronic submission within one business day, ERA payments posted line by line and reconciled against your DMEPOS fee schedule to catch short payments.
Denials, Appeals & ADR Response
Additional documentation requests, redeterminations and reconsiderations answered with a complete evidence packet, inside the payer's deadline.
Reporting & Audit Readiness
Monthly reporting on collections by item category, denial reasons and A/R aging — plus a documentation completeness score so you know your audit exposure.
Categories We Bill
Each item category has its own rulebook
Oxygen coverage criteria look nothing like mobility criteria. Our DME team is organised by category, so the person billing your CPAP claims knows the compliance data requirement without looking it up.
Audit Defence
When the ADR letter arrives, you are already ready
Additional documentation requests, TPE reviews and RAC audits are routine in DME. What separates a nuisance from a recoupment is whether the file was built correctly on day one.
Complete file at submission
Order, CMN, chart notes, qualifying test results and signed POD are assembled and indexed before the claim goes out — not reconstructed two years later.
Same-week ADR response
Documentation requests are answered within days, with a cover letter that maps each payer criterion to the exact page of evidence that satisfies it.
Appeals through every level
Redetermination, reconsideration and ALJ hearing preparation — we track every deadline and escalate rather than write off.
Root cause fed back upstream
Every audit finding becomes a change in the intake checklist, so the same gap does not reappear across the rest of your book.
Documentation scorecard
TopMed DME client averages · Reported monthly
DME FAQ
Common questions from suppliers
Have a recoupment letter in front of you?
Send it over. We will read it, tell you whether it is appealable and what the file needs — before you decide anything about vendors.
Get Free DME AuditDo you work with Medicare, Medicaid and commercial payers?
Can you take over billing mid-rental-cycle?
What if the referring physician's documentation is incomplete?
Do you handle prior authorizations?
Which software do you work in?
How do you charge?
Can you help with accreditation or surety bond requirements?
Free Revenue Audit
Find out what your practice is leaving on the table
Send us a claim sample and your A/R aging report. Within 48 hours you get a written breakdown — no cost, no obligation, no sales pressure.