Streamlining DME Billing & Reducing Claim Denials

Client Profile

Type: Mid-Sized DME & Home Health Provider
Location: Florida, USA
Industry: Durable Medical Equipment (DME)
Engagement Duration: 6 Months
Service Scope: End-to-End DME Revenue Cycle Management

The Challenge

A homecare provider specializing in oxygen supplies, CPAP devices, and mobility aids faced severe cash flow issues due to:

• High claim denial rate (30%)
• Long AR cycles (average 72 days)
• Incomplete documentation from physicians
• Missing modifiers and coding errors
• Delayed insurance verifications

This resulted in $150,000+ in delayed payments and mounting administrative stress.

Bright Health Alliance Intervention

Our DME billing experts conducted a 360° RCM performance audit and implemented strategic process improvements.

1️⃣ Pre-Billing & Documentation Review

Verified all required documents — CMNs, prescriptions, and proof of delivery.
Implemented a payer-specific compliance checklist.
Standardized workflows for faster approvals.

2️⃣ Accurate Coding & Modifier Validation

Corrected HCPCS and modifiers (RR, NU, UE) per DMEPOS guidelines.
Introduced an automated pre-submission modifier check.
Ensured complete alignment with Medicare rules.

3️⃣ Eligibility & Authorization Automation

Deployed a real-time verification tool.
Created payer-specific authorization templates.
Reduced staff time spent on manual follow-ups.

4️⃣ AR & Denial Management Framework

Built a live denial tracking dashboard.
Reprocessed denied claims within 7 days.
Focused on high-value payers for faster recovery.

Results Achieved

Key Metric	Before	After (6 Months)	Impact
Claim Denial Rate	30%	6%	80% reduction
AR Days	72 days	38 days	47% faster reimbursements
Documentation Accuracy	68%	98%	Compliance achieved
Collections	—	+27%	Cash flow improvement

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Client Testimonial

“Bright Health Alliance turned around our DME billing challenges in just a few months.
Their documentation accuracy and denial follow-up made a huge financial difference.”

Key Takeaways

1. Pre-billing quality checks reduce denials dramatically.
2. Proper HCPCS/modifier validation ensures faster Medicare approvals.
3. Real-time reporting builds visibility and accountability.
4. Expert RCM partnership = sustainable revenue growth.

Conclusion

By partnering with Bright Health Alliance, the client achieved:

• Improved billing accuracy
• Reduced denials
• Accelerated collections
• Better compliance with DMEPOS & Medicare rules

Ready to Optimize Your DME Billing?

Let our team handle your RCM challenges — so you can focus on patient care.

📧 info@brighthealthalliance.us
🌐 www.brighthealthalliance.us
📞 +1 (626) 550 1573

👉 Schedule a Free DME Billing Audit Today!