Ensuring Seamless Reimbursement for Essential Equipment: ApexRev Care's DME Billing Solutions
Delivering Durable Medical Equipment requires precision in billing, documentation, and compliance. ApexRev Care ensures accurate claims, faster reimbursements, and financial stability for your DME business with specialized RCM services.
Complete Solutions for Durable Medical Equipment Providers
DME Insurance Verification & Preauthorization
We verify patient eligibility and secure prior authorizations across Medicare, Medicaid, and private insurers — reducing delays and denials.
- Eligibility checks for all payers
- Prior authorization request handling
- Minimized denial rates
HCPCS Coding Accuracy
Our professional coders ensure accurate use of HCPCS Level II codes, modifiers, and bundling rules for all DMEPOS claims.
- Accurate code selection (A-codes, E-codes)
- Correct use of modifiers
- Bundling and unbundling compliance
Timely and Compliant Claim Submission
We handle electronic and paper submissions with payer-specific formatting — ensuring claims are submitted correctly and on time.
- EDI-ready claim processing
- Paper claim submission when required
- Real-time rejection correction
Rental vs. Purchase Billing Strategy
Maximize reimbursements by correctly identifying billable rental cycles vs. outright purchases for equipment like CPAPs, wheelchairs, oxygen units, etc.
- Rental tracking and monthly billing
- Purchase conversion documentation
- Cap period management
Documentation Review & CMNs Support
We assist with Certificate of Medical Necessity (CMN), physician orders, and proof-of-delivery — ensuring documentation meets strict audit criteria.
- CMN and physician order audits
- Real-time documentation checks
- Audit-ready compliance
Proof of Delivery (POD) Compliance
We audit and track POD documents to meet CMS and payer standards, minimizing risk of post-payment denials.
- Track POD by equipment type
- CMS-compliant storage protocols
- Automated alerts for missing PODs
Modifiers & Same-Day Delivery Billing
Expert use of NU, RR, KH, KI, and other modifiers ensures proper payment and documentation for same-day or complex billing scenarios.
- Correct modifier assignment
- Same-day delivery billing guidance
- CMS bundling rules adherence
Medicare Competitive Bidding Compliance
We guide providers through the latest DMEPOS competitive bidding program updates and help maintain CMS compliance.
- Participation guidance
- Bidding documentation support
- CMS rule alignment
Recurring Monthly Rentals Tracking
Our billing software monitors rental timelines, cap limits, and monthly billing cycles — ensuring timely revenue and compliant billing.
- Rental month auto-calculation
- Cap limit alerts
- Real-time revenue insights
DME Billing Workflow
From patient intake to A/R follow-up — streamlined, accurate, and compliant.
Patient Intake & Verification
Key Actions: Collect patient info, verify insurance,
educate patient
Best Practices: Use automated tools, document
communications
Order Processing
Key Actions: Verify prescriptions, gather documents,
assign HCPCS codes
Best Practices: Implement checklists, maintain open
communication with physicians
Prior Authorization
Key Actions: Submit requests, follow-up on approvals
Best Practices: Use electronic systems, train staff on
benefit explanations
Equipment Delivery & Setup
Key Actions: Coordinate delivery, obtain POD, educate
patient
Best Practices: Ensure proper setup, maintain delivery
records
Claim Submission
Key Actions: Prepare and submit claims
Best Practices: Utilize billing software, implement
quality checks
Payment Posting
Key Actions: Record payments, reconcile accounts
Best Practices: Regularly review postings, maintain
detailed records
Denial Management & Appeals
Key Actions: Identify denials, submit appeals
Best Practices: Analyze trends, train staff on appeal
strategies
A/R Follow-Up
Key Actions: Monitor balances, engage in follow-up
Best Practices: Implement automated reminders, maintain
clear communication
Why DME Billing Requires a Specialized Approach
HCPCS Coding Tailored to Specific Equipment
Billing for DME requires specialized HCPCS coding for each type of equipment, ensuring accuracy and compliance with payer rules.
Prior Authorizations for Many Items
Many DME items require prior authorization to ensure coverage, and we assist in obtaining these approvals to avoid claim rejections.
Detailed Documentation to Support Medical Necessity
We ensure that all required documentation supporting medical necessity is complete and meets payer requirements to avoid denials.
Navigating Different Payer Rules
We navigate complex payer rules, including those for Medicare, Medicaid, and commercial insurers, to ensure timely and accurate payments.
Handling Billing for Rentals, Purchases, and Repairs
Our team manages the billing process for DME rentals, purchases, and repairs, ensuring all aspects are covered and compliant with payer requirements.
Compliance with NCDs and LCDs
We ensure compliance with National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) for DME, avoiding potential denials and delays in payment.
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FAQ's
How ApexRev Care Supports DME Providers
ApexRev Care offers targeted solutions for every stage of the DME billing process. From HCPCS coding to fast prior authorization, we ensure your DME claims are processed with precision and speed, enhancing your revenue cycle management.
- ✅ Expertise in HCPCS Coding for all types of DME
- ✅ Fast and Accurate Prior Authorization processing
- ✅ Thorough Documentation Review to meet all payer standards
- ✅ Medicare, Medicaid & Commercial Billing Knowledge
- ✅ Billing for Rentals, Purchases, and Repairs
- ✅ Strict Adherence to NCDs and LCDs
- ✅ DME Reporting on Revenue & Payer Metrics
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