MedCare MSO’s DME billing software is built for HME suppliers and DMEPOS organizations that need HCPCS Level II coding, CMN documentation management, prior authorization tracking, and denial prevention handled in one platform. Durable medical equipment billing operates under rules that general billing tools were never designed to account for. We built ours around those rules from the start.
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The fact remains that most generic billing platforms on the market today do not have built-in rules for DME. They do not know capped rental rules, track CMN expiration dates, or flag prior authorization gaps before submission. These are specific gaps that cost DME billing software companies.
The HCPCS Level II codes change every April, July, October, and January. Suppliers submitting claims using codes that are outdated will be denied automatically by payers and frequently do not receive denial notices returned to them, attaching the reason.
Items such as CPAP devices, oxygen equipment, and hospital beds have specific guidelines that control how they convert from rented to purchased. If a billing team assigns the incorrect KH, KI, or KJ modifier on any of these rental claims, it can cost them and their client significant amounts of money due to decreased payments or denials that are difficult to resolve when tracing back through the claims history.
High-cost items, including power wheelchairs and certain respiratory equipment, require CMS prior authorization before delivery. A claim that submits without the authorization number tied to it creates immediate compliance exposure and uncollectable revenue.
A Certificate of Medical Necessity has a defined validity period. Billing against an expired CMN is one of the most common and most preventable audit findings in Medicare DME billing, appearing repeatedly in CERT error reports because manual tracking consistently fails.
The Physician order, clinical note, and HCPCS code must reflect the same clinical information. Any mismatch between the ICD-10 code and the equipment category billed will result in denial under the local coverage determination guidelines and CMS audit programs.
The rates paid for items in a competitive bidding situation are different based on product category and the zip code of the patient. Billing teams that do not apply the correct competitive bidding area adjustments find collection shortfalls that are difficult to trace after the ERA arrives.
Annual denial rate for DME suppliers according to industry data is attributed to HCPCS coding errors, expired CMN documentation, and missing prior authorization requirements, and has been shown to be avoidable if proper systems are implemented prior to claim submission.
Every feature addresses a specific failure point in the DME revenue cycle. Nothing generic. Nothing that does not earn its place in the workflow.
Validates HCPCS Level II codes against the patient diagnosis, payer requirements, and equipment category before submission. Capped rental modifier logic for KH, KI, and KJ assignments applies automatically based on billing history, removing the manual calculation that generates most rental modifier errors.
Every claim passes through claim scrubbing that checks for missing modifiers, mismatched ICD-10 diagnosis codes, duplicate submissions, and Standard Written Order completeness before a claim reaches the clearinghouse. Flagged claims return with specific error details for immediate correction.
Medicare Part B coverage, Medicaid eligibility, and private payer benefits are confirmed through eligibility verification at intake. Your team knows where coverage stands before equipment leaves the warehouse, not after the claim returns denied.
Prior authorization status is tracked, approval numbers are stored, and every authorization links directly to the corresponding claim. No claim for a prior authorization item is submitted without the approval documentation in place and verified.
Certificates of Medical Necessity and Detailed Written Orders are stored with expiration date tracking and advanced renewal alerts. The most common Medicare audit finding gets addressed before it can occur at the claim level.
Denial management categorizes every rejected claim by reason code and payer, giving your team data to fix root causes rather than individual claims. Built-in appeals workflows and submission tracking cut the average turnaround from denial to resubmission.
Electronic Remittance Advice (ERA) processing posts payments, adjustments, and denials automatically. Underpayments are flagged for immediate follow-up so reimbursement gaps do not go undetected across your aging reports for weeks.
Denial trends by reason code, payer-specific collection rates, and AR aging reports give billing managers the visibility to address revenue cycle management process gaps rather than managing individual denied claims one at a time.
Standard Written Orders, delivery confirmations, clinical notes, CMNs, and prior authorization approvals are organized by patient and claim. Retrievable on demand
Medicare is the largest payer for most DME suppliers and operates under requirements that evolve every year. MedCare MSO provides your practice with medical billing software for DME that will keep you compliant without the need for your billing staff to track all of the regulatory requirements related to the continual updates of HCPCS, DMEPOS fee schedule, and payer policies.
Every quarter, CMS updates the HCPCS Level II code set. The technology automatically updates all HCPCS codes so your billing staff can operate with current codes at all times without having to verify HCPCS between updates.
Payment rates are pulled based on jurisdiction (e.g., state), payer type (e.g., Medicare, Medicaid & 3rd Party), and Item type (e.g., wheelchair, nebulizer). If there are discrepancies with DMEPOS fees on ERA after receipt, you will be able to prove discrepancies prior to submission.
Documentation workflow checklists (or forms), when validated, verify that the orders meet Medicare’s coverage requirements prior to equipment shipment. Any missing data is flagged at the Company’s Intake area of the business process rather than being flagged a few months later during a post-payment audit when reimbursement is already jeopardized.
When diagnosis codes are matched to the corresponding equipment category and compared to the current local coverage determinations (LCD), it ensures that there is sufficient clinical documentation to support the claim meets Medicare Part B coverage criteria prior to submission to a payor for reimbursement.
Medicare has a 12-month standard timely filing window, while most private payors have timeframes as short as 90 days; therefore, the platform allows the Company to flag claims that are approaching their timely filing deadline so that revenue does not go uncollectable due to not filing within the timely filing restrictions.
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