Durable Medical Equipment Billing

Yes. All coding is performed by certified coders, and specialty assignment is deliberate rather than incidental — hCPCS coding tied to an order, a face-to-face encounter, and a medical-necessity record that must exist before delivery.

Three causes account for most of it: documentation assembled after delivery; missing face-to-face encounter record; item not covered under the state plan. Each is a documentation or process failure rather than a coverage dispute, which is why we report denials grouped by cause instead of as a single rate.

Medicaid rules and supplier requirements vary sharply by state, and no post-hoc documentation rescues a claim. That shapes which denials are worth appealing and where the front-end effort should sit, so it drives how we staff the work rather than being background color.

No. Payment is decided by the payer, and any firm promising a collection rate is describing something it does not control. We commit to the process and to six reported numbers you can check against your own system.

Codes are assigned from the documentation the practice provides, and where the record does not support a code we raise a query rather than infer intent. The clinical record and the certification of medical necessity remain the practice's, and claims go out under the provider's own National Provider Identifier.

Yes, which is why this specialty has a page for each state. Workers compensation fee schedules, no-fault auto rules and Medicaid managed-care structure all change at a state line, and each of them changes the billing rather than only the paperwork.