1. Order and Documentation Collection
✔ Receive a signed prescription from the referring provider
✔ Collect detailed written order (DWO) and proof of medical necessity
✔ Include face-to-face notes if required by payer
2. Insurance Verification
✔ Confirm DME benefits and coverage limits
✔ Check authorization requirements and rental vs. purchase policies
✔ Verify frequency and lifetime limits for each item
3. Authorization & Delivery
✔ Submit prior authorization with required documents
✔ Deliver equipment only after approval (if needed)
✔ Obtain delivery confirmation and patient signature
4. Claim Submission & Tracking
✔ Use correct HCPCS codes and modifiers (e.g., NU, RR, KH)
✔ Bill using CMS-1500 form or electronic clearinghouse
✔ Track payment, rejections, and denials weekly
5. Common Challenges & Fixes
| Challenge | Fix |
| Missing or incomplete documentation | Use a checklist before claim submission |
| Claim denied due to modifier errors | Reference payer-specific HCPCS and modifier policies |
| Rental billed as purchase or vice versa | Confirm billing type during insurance verification |
| Delayed payments | Set reminders for authorization follow-up and timely claim entry |
