HME COLUMN
Breaking Billing Bottlenecks
These 4 things could be slowing down your revenue collection
By Tim Freidel
Durable medical equipment (DME) billing is a complex, multistep process with abundant opportunities for impediments to crop up and halt progress.
From order creation to billing, every stage has precise requirements. A missing document, an incorrect code or an incomplete field can impede the process and force staff into rework mode. In most cases, these slowdowns are small, repeatable bottlenecks rather than dramatic breakdowns.
The good news?
DME providers aren’t stuck. By identifying common bottlenecks and implementing systems to address them, you can keep claims moving, reduce denials and improve the predictability of cash flow.
Below, we have identified four key DME billing bottlenecks. Dive in to discover why these bottlenecks matter—and, most importantly, practical methods that can reduce or remove them entirely.
ONE
Errors Caught Too Late
Late-stage errors are one of the most expensive DME billing bottlenecks.
If a mismatch between a diagnosis and a procedure code is identified after delivery, the damage is already done: The product is out, the patient is using it and the claim is now at risk for denial.
Industry studies suggest that reworking a denied claim can cost $25 to $100 in staff time, not including the delay in payment. Multiply that by hundreds of claims each month, and the impact on labor costs and revenue is substantial.
Many late-stage issues can be caught much earlier in the process. For example, if a payer requires a specific form for a certain code, that requirement should be checked before the order moves out of intake.
How can DME providers effectively rectify this bottleneck?
Building early error detection into workflows is key. This can be as simple as creating a pre-billing checklist for each payer and product category, or as advanced as designing automated rules that validate codes and documents against payer guidelines in real time. The goal is the same: to prevent avoidable denials by finding issues before they turn into bottlenecks downstream.
TWO
HCPCS Code Accuracy
The Healthcare Common Procedure Coding System (HCPCS) is a detail-heavy part of DME billing, and it is a frequent source of delays. Each code has specific requirements, and many need modifiers to be accepted. Payer rules vary widely, and code updates or changes in coverage add another layer of complexity.
When staff must manually look up codes, cross-reference payer requirements and verify product matches, the process can slow significantly. If a code is wrong or incomplete, the claim stops until it is corrected, creating a bottleneck that may not be noticed until much later.
Automated HCPCS checking will eliminate much of this delay. A well-designed system applies payer-specific logic to ensure that the chosen code matches the product, includes necessary modifiers and complies with coverage rules.
Regular training is also critical. Even with automation, staff need to understand how codes work, what modifiers mean and when exceptions apply. Combining automation with strong coding knowledge ensures that bottlenecks caused by HCPCS errors become rare rather than routine.
Addressing bottlenecks early & consistently is the best way to stop grinding costs from becoming an accepted part of daily operations.
THREE
Inconsistent Eligibility Verification
Eligibility errors are one of the most preventable causes of DME claim denials, yet they remain a common bottleneck. When insurance coverage isn’t verified up front, claims can be processed for patients who are not eligible for the service or equipment. By the time the issue is discovered, the product has been delivered, and the claim is denied.
The friction here often derives from manual verification methods. Staff may use payer portals or phone calls, which are time-consuming and prone to human error. When teams are busy, these steps might be skipped entirely.
The fix is to move eligibility checks as far forward in the process as possible, ideally at the point of intake. Real-time verification tools integrated into the workflow can instantly confirm coverage, detect plan changes and flag discrepancies before delivery. This reduces denials and prevents unnecessary fulfillment for ineligible patients.
FOUR
Timely Filing Deadlines
Even clean claims can be denied if they are submitted too late. Timely filing limits vary by payer. Medicare allows 12 months, but many commercial payers require claims within 90 or even 30 days of service. Missing these deadlines means lost revenue with no option for resubmission.
The risk often builds slowly. Claims may linger in rework queues while staff wait on documentation, or they may be deprioritized in favor of newer claims. Each passing day chips away at the available filing window until it is too late.
Preventing timely filing denials requires two main safeguards:
- First, track filing deadlines by payer in a visible, centralized way so billing staff know exactly how much time remains.
- Second, set internal submission targets well ahead of payer limits so that claims have a buffer for any last-minute fixes.
Automation can help here as well. Systems that flag approaching deadlines and prioritize those claims for processing reduce the risk of revenue loss. Regular reporting on claims nearing the filing limit also keeps managers aware of potential issues before they turn into hard denials.
Costs Add Up Over Time
Individually, these bottlenecks might feel like small inconveniences—a missing modifier here, a delayed eligibility check there. But in DME billing, even minor slowdowns compound quickly. A single claim held for a week may not seem critical. Multiply that by dozens of claims, and suddenly the impact shows up in higher days in accounts receivable, staff overtime and inconsistent cash flow.
These grinding costs are rarely visible in a single report. They show up as incremental labor increases, subtle revenue dips and delayed patient deliveries.
The real risk is that these delays feed each other. Late eligibility verification can lead to denials, which then push claims closer to timely filing deadlines. Missing patient details can stall coding, which in turn delays error checks. Each small gap reinforces the next, creating a cycle that is difficult to break without intentional process changes.
Addressing bottlenecks early and consistently is the best way to stop these grinding costs from becoming an accepted part of daily operations. Tight workflows, proactive checks and clear accountability keep claims moving smoothly and keep the slow drip of hidden expenses from turning into a flood.
Timing Matters
The common thread across these bottlenecks is timing. The earlier an issue is identified, the easier it is to resolve without disrupting the flow of claims. Automation, consistent workflows and clear rules at each stage help ensure that problems are caught at their source, not after they have created delays.
The result is a billing process that is faster, more predictable and less burdensome for staff.
In an environment where margins are thin and compliance requirements are strict, removing bottlenecks is essential for financial stability and sustainable growth.
Tim Freidel is the CEO and founder of DME Flow, a workflow automation platform that fits into existing electronic medical records systems. He is focused on helping durable medical equipment and home medical equipment providers automate billing and order workflows without needing to change systems or processes. Visit dmeflow.ai or reach him at tim@dmeflow.ai
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