DME Case Study
Catching DME Underpayments During Payment Posting
Payment posting and reconciliation | Underpayments, ERA/EOB review and payer follow-up
These are illustrative scenarios built around billing problems DME suppliers commonly run into. The figures are examples, not results from a specific client.
The challenge
A growing DME supplier billed Medicare and several commercial payers, each with its own contract terms, adjustment habits and remittance format. Staff posted payments, but nobody routinely compared what was paid with what should have been paid.
Short pays, partial payments and adjustments nobody could explain sat on accounts for weeks.
What we did
- Matched payments from 835 ERAs and paper EOBs to the right claims and accounts.
- Compared each allowed amount with the contracted rate, or the fee schedule where one applied.
- Read the group codes, CARCs and RARCs to separate expected contractual adjustments from ones that needed a second look.
- Routed each confirmed discrepancy to the right fix: a reopening, a corrected claim, a reconsideration or a formal appeal, depending on the payer.
- Tracked open balances against each payer’s filing deadlines and recorded how every case ended.
Results
| Metric | Before | After |
|---|---|---|
| Potential underpayments identified (per month) | 35 | 85 |
| Payment discrepancies unresolved after 30 days | 95 | 35 |
| Average reconciliation turnaround | 12 days | 5 days |
| Verified underpayment dollars recovered (per month) | $8,000 | $24,000 |
What changed
The team flagged more than twice as many potential underpayments each month, and the number left open past 30 days dropped from 95 to 35. Recovered dollars went from $8,000 to $24,000 a month. That’s money actually collected on verified underpayments, not billed charges.
What can be recovered depends on contract terms, payer policy and appeal deadlines, so each discrepancy has to be validated first.
Takeaway
Posting a payment and checking it are two different jobs. If no one compares the allowed amount with the contract, underpayments just look like normal adjustments.
Not sure your payers are paying what they owe? Get a free billing audit.
How Salyx RCM helps DME suppliers
Same-or-similar conflicts, unchecked payments and delivery-to-billing delays are three of the most common places DME suppliers lose time and cash. We work on the billing side of all three.
- DME and respiratory billing
- CPAP billing and recurring supplies
- AR follow-up and denial management
- Payment posting and ERA/EOB reconciliation
- Eligibility checks and prior authorization
- Documentation follow-up and claim readiness
- Revenue cycle reporting
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