DME Billing Services for Durable Medical Equipment Suppliers
Most DME claims are decided before the item ever leaves your warehouse. If the written order is missing an element, the prescriber’s notes don’t meet the LCD, or a rental month goes out with the wrong modifier, the payer will deny it no matter how fast you filed. Salyx RCM’s DME billing services start with the paperwork: we work next to your intake staff to catch gaps while they can still be fixed, then stay on each claim until it’s paid.
Where DME claims usually break down
Orders and documentation
Medicare's standard written order needs the beneficiary's name or MBI, the order date, a description of the item, the quantity, the prescriber's name or NPI, and a signature. Items on the CMS list that require a face-to-face encounter and a written order prior to delivery (WOPD) need both before you deliver. CMNs and DIFs were retired for most dates of service from January 1, 2023, but the medical record still has to support the LCD criteria, and some Medicaid and commercial plans kept their own forms. Proof of delivery belongs in the file too.
Modifiers that change payment
KX tells the DME MAC that coverage criteria are met and documented, so it should never go on a claim out of habit. RR, NU and UE mark rental, new purchase and used purchase. Capped rental months take KH, KI or KJ, and GA or GZ show whether an ABN was signed. Orthotics usually need LT or RT. A single missing or conflicting modifier can reject the whole line.
Capped rentals and oxygen
Capped rental items pay month by month for up to 13 continuous months, and then ownership passes to the beneficiary. Hospital stays, breaks in need and supplier changes all affect that count. Oxygen runs on a 36-month payment period and a five-year reasonable useful lifetime. Across hundreds of active rentals, small counting mistakes become missed or duplicate months.
Prior authorization
Medicare's Required Prior Authorization List covers certain power mobility devices, pressure-reducing support surfaces and orthoses, and the claim must carry the unique tracking number (UTN) from an affirmed request. Medicare Advantage, Medicaid and commercial plans keep separate lists with their own unit limits and end dates.
Supplier standards
Billing Medicare means meeting the DMEPOS supplier standards, keeping accreditation and your surety bond current, revalidating on schedule, and sending claims to the DME MAC for the beneficiary's state of residence. Fee schedules and competitive bidding rules change from time to time, so pricing needs a periodic check.
Resupply
CPAP accessories, diabetic testing supplies and urological items carry frequency limits and refill documentation rules. For Medicare, you generally can't contact the beneficiary about a refill more than 14 days before delivery, or ship more than 10 days before the current supply is expected to run out.
Our Services
How Salyx RCM supports DME suppliers
Intake and eligibility
Before delivery is scheduled, we run eligibility verification across Medicare, Medicare Advantage, Medicaid and commercial plans, do same-or-similar checks, confirm network status and deductibles, and review the order for missing elements.
Prior authorization
Requests are submitted and tracked to a decision. UTNs and approval dates go into the record, and rentals or resupply orders are flagged well before an approval lapses.
HCPCS coding and modifiers
Certified coders on our medical coding team check HCPCS Level II codes, units, rental and purchase modifiers, KX use and diagnosis codes against the applicable LCD.
Claim submission
Initial claims and recurring monthly rentals are scrubbed and sent to the correct DME MAC or payer as part of our claim submission work.
Payment posting
ERAs and EOBs are posted so rental month counts stay in step with what was actually paid. Anything below the fee schedule or contract rate gets flagged.
Denials and appeals
Missing documentation, same-or-similar conflicts, frequency limits and modifier errors each need a different fix. Our denial management staff choose the right route: a corrected claim, a reopening or a redetermination.
Credentialing
We handle payer enrollment with commercial and Medicaid plans and keep track of your Medicare revalidation dates.
Patient balances
Statements for rental coinsurance and purchases are written in plain language, and our staff answer patients' billing questions when they call.
Reporting
You'll get regular reports on AR aging, denials by payer and reason, and authorizations coming up for renewal.
Compliance
We sign a Business Associate Agreement with each supplier we work with. Orders, delivery records and patient data are handled under HIPAA-compliant processes, and only the staff working your account can see them.
How It Works
Our process
1. Discovery call
We learn your product mix, payers and billing software, and where claims are getting stuck.
2. Workflow review
Order intake, document handling and recent denials get a close look, and we agree on who owns each handoff.
3. Onboarding
Secure access, payer-specific checklists and a direct line to your team are set up.
4. Daily work
Verifications, authorizations, coding, claims, posting and follow-up run on the schedule we agreed.
5. Ongoing review
Regular check-ins cover open AR, repeat denial causes and what to change at intake.
Related reading
Sleep studies and CPAP
Many CPAP claims depend on the study report. Our page on sleep lab billing explains what the lab side needs to document.
Prior authorization
Practical intake fixes are covered in why prior authorization delays start at the front end.
Denial prevention
A walk-through of what happens to a claim in the minutes before it gets denied.
Frequently Asked Questions
What suppliers usually ask before handing over their DME billing.
1. Do you bill Medicare DME MACs as well as commercial and Medicaid plans?
Yes. We bill the DME MACs, Medicare Advantage plans, state Medicaid programs and commercial payers, and each claim is checked against that payer’s coding, modifier and documentation rules before it goes out.
2. Can you track capped rentals and oxygen billing periods?
Yes. We track rental months, the right capped rental modifiers, and events like hospital stays or breaks in service that change the count. Posting and rental tracking are kept in sync so months aren’t skipped or billed twice.
3. What happens when a claim is denied for missing documentation or a KX issue?
We find the cause, get the missing order or record elements from your team or the prescriber, and then correct and resubmit or appeal, whichever fits. Repeat causes go into our reports so they can be fixed at intake.
4. Do you handle prior authorization for power mobility devices?
Yes. We prepare and track requests for items on Medicare’s Required Prior Authorization List and for any plan that requires approval, and we make sure the UTN or authorization number is on the claim.
5. Can you work inside our current DME billing software?
Yes. We work inside the system you already have, including DME platforms like Brightree, Bonafide, NikoHealth and TIMS, and others. You control the access, and there’s no need to switch software.
Other specialties we serve
Salyx RCM also handles billing for these related specialties.
Home Health Billing
PDGM coding, NOA timing, LUPA thresholds and signed orders.
Hospice Billing
NOE timing, levels of care, certifications and the hospice cap.
Infusion Billing
Drug units, NDCs, JW and JZ modifiers and administration codes.
Vision Billing
Routine and medical eye exams, refraction and vision plans.
Talk to our DME billing expert
If orders sit on hold, rental months get missed or authorizations lapse before delivery, let’s go through your claims together. The first consultation is free. Call (321) 788-3655 or email info@salyxrcm.com.