DME Practice Billing

Business Challenges

The client, a multi-branch Durable Medical Equipment (DME) provider, was seeking an outsourcing partner capable of delivering in-depth reimbursement research and end-to-end billing support. They required a professional team that could operate at a competitive cost while maintaining rapid turnaround times.

While I-Conic Solutions had successfully managed similar engagements, this project presented added complexity. The client required extensive research across multiple DME product lines, payer policies, and billing workflows — all to be executed under a 6-FTE model supporting 21 branches.

Initial Setup

At the start of the engagement, the revenue cycle environment showed significant gaps:

• Total Accounts Receivable: $1M+
• Insurance A/R: $700K (with 90+ day A/R at ~85%)
• Patient A/R: $250K
• Monthly Collections: $120K
• Average A/R Days: 90 days
• Unbilled Charges: $150K+

Operational Gaps

• Denials were not being worked promptly, and denial documentation was inconsistent.
• Patient A/R was disorganized, with statements not generated on time.
• Claims follow-up processes were weak or inconsistent.
• Billing was skipped for several branches.
• Many claims were submitted out-of-network.
• Authorizations were missing on numerous claims.
• EFT enrollment had not been completed.
• Network participation with major payers was limited.
• A majority of claims were still being submitted via paper.

Billing Optimization Initiatives by I-Conic Solutions

• Centralized Documentation Access
  Created a secure shared drive and provided login access to all branches to ensure no documentation or billing activity was missed.
• EFT Enrollment Expansion
  Initiated and completed EFT setup with the majority of payers to accelerate payment posting.
• Credentialing & Network Participation
  Completed payer credentialing and expanded in-network participation across key insurance plans.
• Pre-Delivery Benefit & Authorization Checks
  Implemented mandatory eligibility and authorization verification prior to product delivery.
• Procedure & Payable DX Guidance
  Distributed standardized procedure and diagnosis reference lists to all branches.
• CMN Management
  Requested revised Certificates of Medical Necessity (CMNs) when required to proactively prevent denials.
• Field Team Training
  Conducted bi-weekly training sessions for field representatives to strengthen billing awareness and compliance.
• Electronic Claims Adoption
  Transitioned branches from paper to electronic submissions, reducing costs and improving turnaround times.

A/R Reduction Strategy

Workflow Assessment
Conducted detailed teleconferences with the client to understand existing operational gaps.

Charge & Coding Review

• Audited charge capture processes.
• Identified modifier and procedure coding errors.
• Implemented standardized billing and coding rules.

Unsubmitted Claims Recovery
Identified claims that were never filed due to system issues and corrected the technical gaps.

Rejection Analysis & Prevention
Analyzed electronic rejection reports and educated the client on root causes, significantly reducing rejection rates.

Patient Statement Automation
Established structured patient statement cycles and audited all four billing cycles when necessary to prevent A/R buildup.

Patient A/R Policy Design
Developed customized patient A/R policies aligned with the client’s workflow.

Timely Filing & Appeals
Prioritized claims nearing timely filing limits and submitted strong, documentation-backed appeals.

Payment Allocation Cleanup
Corrected incorrectly posted patient co-insurance and deductible amounts.

Diagnosis Code Updates
Worked with the software team to eliminate outdated default diagnosis codes.

Proactive Operational Reporting
Delivered frequent reports, including:

• Error reports
• Missing charge reports
• Future appointment tracking

This improved visibility into patient flow and revenue leakage.

Key Achievements

Peak Performance:
Highest collections reached $247K within five months of I-Conic Solutions taking over the account.

Conclusion

By partnering with I-Conic Solutions, the DME provider gained full visibility and control over its revenue cycle operations. Through structured billing workflows, payer alignment, and aggressive A/R management, the organization significantly reduced outstanding receivables and nearly doubled monthly collections.

The engagement established a scalable financial foundation that supported multi-branch growth and long-term operational stability.

Customer Testimonials

“After 20 years in the DME business, we finally have full visibility into our financial performance. The results are clearly reflected in our bank deposits. The bi-weekly training for field representatives and the managed pre-billing activities have been outstanding. I highly recommend I-Conic Solutions.”

“Thank you, I-Conic Solutions. We have added three new large branches, and they are extremely pleased with their collections and your team’s prompt responsiveness.”