DME and Orthotic Supplies billing and accounts receivable

Durable medical equipment is documentation billing: the order, the face-to-face, the medical necessity and the delivery all have to exist before the claim does.

Where the money leaks in DME and orthotic supplies

These are the recurring denial reasons in this specialty. They are not exotic. They are the ordinary ones that go unworked because the person who could fix them is at the front desk answering a phone.

• Missing or non-compliant written order prior to delivery
• Face-to-face encounter not documented inside the required window
• Rental and purchase billed against the wrong cap or continued past it
• Missing modifiers identifying new, used, rented or replacement equipment
• Proof of delivery absent when the payer audits, turning a paid claim into a takeback

What a seat does about it

One trained person works your queue from the difficult end, from our office in Rawalpindi, Pakistan, logged into your own system on your hours. Every call is logged with the payer reference number and the outcome, so an appeal can quote what was said rather than start again. Denials are categorised, which is how the same reason stops coming back next month. On Friday you get it in writing. Some payer contracts and some state Medicaid programs restrict or require disclosure of offshore access — check yours before placing a restricted queue on this seat (more on /security/).

The roles that matter most in this specialty are AR calling and denials at $1,700, prior authorization at $1,900, and medical coding at $2,500, on request.

The codes those turn into

Each of these is a denial code you are likely to meet working DME and orthotic supplies, matched to the problem above it in your own words. The route back to payment differs by code, so a queue sorted by recovery route clears faster than one sorted by date.

• CO-4 — Modifier and code disagree
  The code and the modifier disagree, or a modifier the payer required was not there.
  Recovered by being corrected and resubmitted. Matched from: “Missing modifiers identifying new, used, rented or replacement equipment”

Working a denied claim costs $57.23 per denied claim in administrative time (source), and payers ultimately pay roughly 90% of claims even while using an initial denial to slow payment. Most of what sits in a DME and orthotic supplies AR bucket is not lost money. It is money waiting for somebody with the hours to make the call.

Questions