DME Practice Billing

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Business Challenges

The client was looking for an outsourcing partner who could provide important research data on reimbursements and billing of DME products. They wanted to partner with a professional service provider who could provide the services at a very competitive price and within a quick turnaround time.

Although similar to many other projects we have completed, the main challenge was that the client wanted us to perform in-depth research for various DME products, DME billing processes, insurance coverage, and update spreadsheets accordingly under 6 FTE for 21 different branches.

Setup:

• Total AR: $1 million+
• Insurance AR: $700K (90+ AR at 85%)
• Patient AR: $250K
• Collections: $120K
• AR days: 90 days
• No prompt denial handling or documentation
• Patient statements not generated on time
• Over 150K charges unbilled
• Billing skipped for many branches
• Claims processed out-of-network
• Missing authorizations on many claims
• EFT setup not done
• No network participation with major insurers
• Most claims submitted via paper

Steps to Streamline Billing

• Shared drive setup and access to branches to avoid missing documentation
• EFT setup with most payers
• Credentialing and network participation initiated
• Benefit verification and authorizations before delivery
• Shared list of procedures and payable diagnoses with branches
• Revised CMNs requested where needed
• Bi-weekly training provided by Spinfluence Services to field reps
• Electronic submission implemented to cut costs and delays

Steps to Reduce AR

• Teleconferences to understand client workflow
• Charge errors reviewed; billing rules and coding guidelines established
• System glitches fixed to ensure all charges were filed
• Analyzed rejected claims; trained client to reduce rejection rate
• Scheduled and audited patient statements for all 4 cycles
• Defined patient AR policies tailored to the practice
• Handled appeals for claims nearing timely filing limits
• Fixed co-insurance and deductible allocation errors
• Resolved outdated diagnosis code issues with software team
• Sent regular reports on errors, missing tickets, appointments, and billing gaps

Key Achievements

• Current Total AR: $500K
• Insurance AR: $300K
• Patient AR: <$50K
• Collections: $200K – $230K
• Highest collection achieved: $247K in 5 months

Customer Testimonials

“After 20 years in DME business, I got visibility on my business, result can be seen in my bank credits. Bi-weekly training to field reps and managed pre-billing activities are awesome. I would recommend Spinfluence Services.”

“Thank you Spinfluence Services! We have added 3 new large branches and they are pleased with their collection and your prompt response on anything they are looking for.”