DME Billing
DME Billing
Accurate HCPCS
Claim Scrubbing
Denial Identification
Submission Monitoring
Simplify durable medical equipment billing with Emerger RCM. We ensure compliance, accurate coding, and efficient claims processing for all DME items helping you maximize reimbursements, reduce denials, and secure timely cash flow.
Eligibility & Documentation Management
We begin by verifying patient insurance eligibility for DME services and capture all required documentation including physician orders, Certificate of Medical Necessity (CMN), and Proof of Delivery (POD). Our team ensures these forms meet payer-specific requirements before claim creation. This not only prevents submission delays but also minimizes denial rates.
By proactively managing authorizations and documentation, we ensure each DME claim is supported with the proper medical justification and administrative compliance.
Coding, Billing & Claims Submission
Once documentation is verified, our certified coders assign precise HCPCS, CPT, DMEPOS, and modifier codes, ensuring 100% code specificity and alignment with payer fee schedules. Claims are scrubbed using customized system rules and submitted promptly either electronically (EDI) or via hybrid methods. We manage submissions to Medicare, Medicaid, and commercial payers, track acknowledgment reports, and act swiftly on rejections. This thorough process supports faster reimbursements and reduces claim backlog.
Contact us today to learn more about our team
We would be happy to answer any questions you may have or provide you with additional information about our services.
Electronic EDI Integration
Seamless claims transmission via EHR, EDI or third-party clearinghouses.
Accurate HCPCS & CPT Coding
Specialized coders ensure precise coding from E0100–E8002 ranges with correct modifiers.
Documentation & Authorization Tracking
Manages CMN, POD, and prior auths for full billing compliance.
Payer‑Specific Fee Schedules
Aligns coding and pricing with Medicare, Medicaid, and commercial payers.
Claim Scrubbing & Submission Monitoring
Pre‑submission validation, batch uploads, and real‑time monitoring of acknowledgments.
Denial Identification & Appeal Support
Reviews EOBs to flag denials and initiates appeals or resubmissions promptly.
DME claims require thorough verification of a patient’s insurance benefits especially for coverage of specific devices. We check eligibility, benefits, co-pay, and deductible details prior to billing. When required, we handle prior authorization (PA) by submitting all relevant medical documentation and follow-up outreach until approval is received.
This ensures a clean pathway to reimbursement and reduces avoidable claim denials due to authorization issues.
Our certified coders specialize in durable medical equipment billing, covering mobility aids, CPAP, prosthetics, diabetic supplies, and more. They apply the correct HCPCS codes (E0100–E8002), CPT billing procedures, and DMEPOS modifiers. Documentation compliance such as proper CMN and POD is confirmed to support medical necessity.
This expert coding ensures accurate reimbursements, reduces PPS-based denials, and reinforces audit readiness by maintaining code specificity and payer-specific coding rules.
Proof of Delivery is critical for DME reimbursement. We monitor CMN expiration, compliance documentation, and POD submission requirements. When shipments are fulfilled, we ensure the POD is signed, timestamped, and properly attached to the claim.
If digital POD isn’t available, we follow payer guidelines for paper versions. This attention to detail protects your claims from rejection or fraud scrutiny, ensuring claim integrity and confirming that delivered services are verifiable.
DME claims are vulnerable to denials due to coding errors, missing documentation, or medical necessity issues. Our team reviews denials in real time, categorizes them by reason, and corrects claims for resubmission or appeals. Appeals are supported by supplemental documentation, including revised CMN, physician notes, and equipment manuals when needed. We track appeal status and communicate outcomes to you, helping recover denials and reducing future claim volume.
Our DME billing dashboard provides insights into claims volume, denial rates, payer profitability, and item-specific performance. We highlight trends for example, if particular HCPCS codes are frequently denied. Monthly reports offer recommendations such as updated authorization workflows, code usage tweaks, or process improvements.
This continuous refinement keeps your billing clean, efficient, and aligned with best practices in DME reimbursement.
