DME billing. From the order to the billing cycle.

Review the order, insurance information, relevant documentation and any prior authorization requirements for the actual equipment. Track payer references and outstanding clinical or supplier records.

Review documented equipment and supplies against applicable HCPCS and ICD-10 information, modifiers and payer requirements. Keep the relevant L-code or K-code item category connected to the documented equipment and current payer requirements. Laterality and requirements-met questions must be supported by the record and the applicable payer requirements.

Track documented rental-to-purchase timelines, relevant capped-rental rules and billing periods for the actual item and payer. Review phase-transition questions against current requirements for the actual equipment and payer.

Review relevant usage limits, resupply schedules and documentation milestones using the supplier’s records and applicable payer policies. Distinguish a scheduled review from an entitlement to replacement supplies. Confirm responsibilities for obtaining required source information.

Review orthotic and prosthetic billing, surgical and non-surgical contexts, relevant item classifications and clinical support. Review current Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs) and payer requirements.

Review respiratory equipment, oxygen documentation, CPAP or BiPAP records, rental context and Medicare or commercial requirements. Clinical criteria and source records must come from authorized providers.

Review wound care supplies, collagen or antimicrobial dressing context and the matrix-related billing questions as topics requiring careful item and payer review. Connect the documented product, order and clinical support to current coverage rules.

Review the documented mobility aid and relevant order, face-to-face or clinical support requested by the payer. For clinical contexts such as ALS or MS, use the provider’s documented functional information when reviewing an equipment request.

Discuss the supplier’s size and any pediatric, hospice-related or cross-border billing context before defining the engagement. Confirm the specific supplier, patient context, jurisdiction and responsible payer before accepting work.

Review claims against available documentation and payer requirements, track submission responses and follow filing deadlines. Any electronic route depends on confirmed system access and compatibility.

Review payer reasons, coding questions, remittance information and outstanding balances. Track supported corrections, appeals and underpayment inquiries with the item and billing-period record. Review A/R age and prior correspondence without promising to eliminate denials or guarantee collections.

Reconcile payer payments, adjustments and balances, and review claims, denials, A/R and rental or resupply status using agreed definitions. Set out service responsibilities, response expectations and reporting cadence in the agreement.

Organize the relevant orders, equipment records, supporting clinical information and claim correspondence for an agreed review. Use current CMS, Medicare Administrative Contractor (MAC) and payer requirements where applicable. Confirm the requesting organization, current requirements and response responsibilities for each payer or audit request.

Assess the supplier’s existing systems, approved access, compatibility and staff handoffs before workflow changes. Agree any permitted manual documentation exchange.