DME Billing Services for HME and O&P Suppliers, $0 Setup

Who our DME billing service is for

Our DME billing service is built for suppliers that bill equipment month by month: HME and respiratory companies with CPAP and oxygen rentals, mobility suppliers with power and manual wheelchairs, orthotic and prosthetic suppliers, and diabetic and resupply businesses. Physician practices that dispense braces under their own DMEPOS supplier number can send those claims to us as well, while our orthopedic billing team bills the surgeon side. Podiatry practices that dispense diabetic shoes can do the same.

Hand your DME billing to us when:

• the biller who kept the rental month counts has left, and nobody knows which month each patient is on;
• prior authorization decisions, delivery tickets and orders live in three places, and claims go out without one of them;
• recoupments arrive for rentals paid months ago, and A/R past 90 days keeps growing while the team works intake.

What we take over and what your DME company keeps

We take over the payer side of your DME revenue cycle, from the order check to the posted payment. Your team keeps intake, delivery, patient contact and your supplier enrollment. We check every code against your clinician's documentation and never change a code without the clinician's sign-off. Rejected and denied lines go through our denial work and appeals queue, and coverage questions start with eligibility checks before delivery. The figure shows a month of our DME billing.

Read the workflow as text

1. Check order and auth — Order elements, encounter date and any prior auth decision checked before the claim goes out. Owner: Our billing team.
2. Match delivery to claim — Signed proof of delivery names the same item, code and date. Owner: Your delivery staff.
3. Bill each rental month — Each month billed with its rental modifier; KX only with documented criteria. Owner: Our billing team.
4. Hold refills until confirmed — Resupply claims wait for the patient's documented request inside Medicare's window. Owner: Our billing team.
5. Post and work denials — Rental month count updated; each denial worked within 2 business days of posting. Owner: Our billing team.
6. Monthly KPI report — KPIs with written definitions by the 10th of each month. Owner: Sent to you.

Where DME suppliers lose revenue, and what we do about it

A DME claim with the right HCPCS code still fails when the order, the authorization or the delivery record behind it is missing. We check these points on every DME claim.

Before the claim: orders, authorizations and coverage criteria

• An incomplete order. 42 CFR 410.38 lists six elements every DMEPOS order needs, and power mobility devices and other listed items also need a face-to-face encounter in the 6 months before the order date. We check both on every claim and send any gap back to you before it goes out.
• A growing prior authorization list. CMS adds six more items to required prior authorization nationwide on October 28, 2026, among them a manual wheelchair, an air-fluidized bed and a knee orthosis. We log every decision and its expiry against the delivery date.
• KX without the record behind it. Noridian's DME MAC guidance calls adding KX without verifying the coverage criteria and documentation incorrect use. We add KX only after the record shows each criterion.

After delivery: proof, rental months and refills

• Proof of delivery missing when CMS asks. Without it in the required timeframe, CMS says claims are denied and overpayments recouped, so a rental paid months ago can come back. We match the delivery record to the claim before release.
• Rental months miscounted. Medicare pays a capped rental for no more than 13 months of continuous use. We keep each rental's paid-month count to guard against a month being billed twice or skipped, and flag the title-transfer date before month 13 posts.
• Refills shipped on a calendar. The DMEPOS refill rule needs the patient's confirmation within 30 days of the supply's expected end. We hold refill claims until that confirmation is on file.

Before you decide, send us your aging export for The Free A/R Deadline Map, delivered in 5 business days. Clock starts with your claim-level aging export and signed BAA; above 10 requests in a week, we confirm your date within 1 business day.

What our DME billing costs

DME suppliers get a written quote instead of a size band, because our rate card counts rendering clinicians and a supplier bills under one supplier number. Your fee is a percentage of insurance payments and 0% of patient payments, so the coinsurance your team collects at delivery never carries our fee. Every term is on the full rate card; to get your quote, tell us your monthly claim volume and payer mix.

How we start: switching your DME billing from in-house or another company

Rental month counts slip first when DME billing changes hands: bill month 7 twice, or skip it, and the paid-month record no longer matches the 13-month cap. Claims near a filing deadline come next. Your DME company sends us six things in the first week:

1. Service agreement and BAA, both signed.
2. Access to your DME billing software, your clearinghouse and your DME MAC portal account.
3. A claim-level aging report, so we can order inherited claims by deadline.
4. Every active rental, with its start date and the last month billed.
5. Pending prior authorization requests and the decision letters already received.
6. A kickoff call with whoever runs billing today.

Go-live, when your first claims go out, comes within 5 business days of access; any unbilled backlog follows within 10 business days of access. Clock starts with your signed agreement, signed BAA and working system logins; it extends day for day while we wait on access. Every inherited claim within 30 days of a filing, corrected-claim or appeal deadline is worked within 5 business days of access. Starts at access; covers up to 250 claims (more gets a day-1 deadline schedule); worked means submitted, corrected, appealed or returned with the fix.

Leaving another vendor? The billing handoff plan lists the files to request from them.

What we report each month and the guarantees behind it

Two written guarantees back our DME billing, each with its terms in full:

• On-Our-Watch Guarantee: If a claim misses a filing, corrected-claim or appeal deadline while it is on our watch, we pay you what it would have paid. Claims we get complete 10+ business days before the deadline; contracted rate less any copay you collected, paid automatically within 30 days of final denial; capped $10,000/month; your holds excluded.
• Clock-or-Credit Guarantee: From go-live, every new claim goes out within 1 business day of complete charge data, and every denial is worked within 2 business days of posting — or $25 comes off your invoice for each late one. Mon–Fri ET business days by your system's timestamps; worked: resubmitted, appealed or returned with the fix; auto-credited; capped at monthly fee; clearinghouse outages excluded.

No billing company can make a DME MAC affirm a prior authorization or pay a claim the documentation does not support. What we guarantee, on the terms above, is the deadline and the clock.

What the monthly DME report shows

The KPI report arrives by the 10th of each month with written definitions for clean claims, A/R days and net collection rate. Between reports, we tell you as each prior authorization nears its expiry and as each rental nears its title-transfer date. We publish client results only with written permission. Until we have them, judge us by the guarantees and the free Deadline Map.

Your billing software, supplier enrollment and data access

We work inside your existing practice-management system and clearinghouse; tell us which ones and we confirm in writing within 1 business day. See the systems we work in. We sign a BAA before we touch patient data, and every payment goes to your own bank account.

Your Medicare DMEPOS supplier enrollment and accreditation stay in your company's name, and we bill under them. When your quote includes them, our prior authorization requests go out as one complete packet: the order, the encounter note and the documentation the policy asks for.

Common questions

How much do your DME billing services cost?

16+ clinicians, or anesthesia, radiology, DME, lab and home health: written quote within 1 business day, same fee base, cap and terms. The fee is a percentage of insurance payments, with 0% of patient payments and $0 setup. The minimum, cap and contract terms are under DME billing pricing.

Do we have to sign a long-term DME billing contract?

No. Leave with 30 days' notice and no termination fee. Want a run-out? We keep working the claims we submitted for 90 days at your plan rate. Decline it and we charge nothing on payments that post after you leave. Notice by email; optional run-out covers claims we submitted before your exit date, at your plan rate; handover file within 10 business days of exit.

How fast can you take over our DME claims?

Go-live, when your first claims go out, comes within 5 business days of access; any unbilled backlog follows within 10 business days of access. Clock starts with your signed agreement, signed BAA and working system logins; it extends day for day while we wait on access. The six things we need from your DME company are listed under how we start.

Can you handle rentals already in progress when we switch?

Yes. Send us every active rental with its start date and last billed month, and we continue the paid-month count from there, to guard against a month being billed twice or skipped and to keep each title-transfer date on schedule.

Do you handle prior authorization for items on the CMS list?

We track every decision and its expiry against the delivery date for every item on the CMS Required Prior Authorization List, and file the requests when your written quote includes them. See our prior authorization service.

Can you handle CPAP rentals past the first three months?

Yes. We track each patient's usage and re-evaluation dates against the DME MAC's PAP policy (in Jurisdiction D, both fall inside the first 91 days) and flag a gap to you before the fourth rental month is billed.

Do you bill Medicare Advantage and commercial plans as well as the DME MACs?

Yes. Medicare Advantage DME claims go to the patient's plan, not a DME MAC, so we confirm coverage before the item ships and bill whichever payer covers each rental month, including commercial plans and state Medicaid.

Which DME billing software do you work in?

We work inside your existing practice-management system and clearinghouse; tell us which ones and we confirm in writing within 1 business day. See EHR and practice-management compatibility.