Tag: Documentation
Compliance: Implement a pre-billing review
October 6, 2026Cheryl Henninger
Q. What documentation should be in place before a DME claim is submitted?
A. A DME claim should not reach billing until the patient file already supports the item ordered, the patient’s eligibility and medical need, and the provider’s compliant delivery of service.
Start with the order. It should be complete, signed and specific enough for the item and accessories being billed. Then review the medical record to confirm it supports the diagnosis, coverage criteria and continued need....
Compliance: Put billing, accreditation into same silo
September 9, 2026Cheryl Henninger
Q. How can DME providers better align billing documentation with accreditation readiness?
A. The first step is to stop treating billing compliance and accreditation compliance as two separate jobs. In a strong DME operation, they should be looking at the same patient story from two different angles.
Billing asks: Do we have what we need to support medical necessity, coverage, coding, modifiers, continued need and delivery? Accreditation asks: Did we follow our policies, educate the patient,...
Ventilation: Include patient’s story in documentation
September 9, 2026Boone Lockard
Q. Why is telling the patient’s story through NIV documentation so important under the new CMS policy?
A. As CMS places greater emphasis on clinical justification for non-invasive ventilation (NIV), providers must recognize that a diagnosis alone is no longer enough to support medical necessity. Success under the new policy depends on comprehensive documentation that clearly demonstrates the patient's condition, symptom burden, disease progression and the ongoing need for therapy.
The...
Newtn Digital debuts platform to modernize DME workflow
June 22, 2026HME News Staff
AUSTIN, Texas – Newtn Digital has launched a platform designed to streamline ordering, documentation and claims processing for durable medical equipment (DME) providers. The company says the platform connects health care providers, physicians and DME providers through a secure workflow that reduces paperwork, improves documentation accuracy and helps accelerate reimbursement. "Health care has modernized many aspects of patient care, but DME workflows have remained largely stuck in a paper-based...
CRT providers wrangle with repairs and prior auth exemption
June 19, 2026Liz Beaulieu, Editor
WATERLOO, Iowa – Complex rehab technology (CRT) providers continue to face persistent challenges with documentation and billing for wheelchair repairs, according to Dan Fedor of U.S. Rehab, who addressed the issue at the recent VGM Heartland Conference.
Fedor, director of reimbursement and education for U.S. Rehab, a division of VGM & Associates, said repairs remain one of the most common operational pain points for providers – accounting for roughly 30% of his daily communications...
In brief: Palladium invests in DME Express, CMS adopts e-standards, MFCU racks up cases
March 23, 2026HME News Staff
NEW YORK and THE WOODLANDS, Texas – Palladium Equity Partners has announced an agreement to acquire a majority equity interest in DME Express, a provider of durable medical equipment (DME) serving hospice providers across the U.S., from WayPoint Capital Partners, which will maintain a minority equity interest.
Palladium, which has more than $3 billion in assets under management, expects to partner with CEO Mark Borneleit and his founding team to continue to lead the business.
"DME...
In brief: Health care spending, prior auth list, fraud division
January 16, 2026HME News Staff
WASHINGTON – Health care spending in the U.S. reached $5.3 trillion and increased 7.2% in 2024, similar to 7.4% in 2023, as increased demand for health care influenced this two-year trend, according to a new article in the journal Health Affairs.
Health care spending growth continued to outpace overall economic growth
As a result, the health care share of the economy increased from 17.7% in 2023 to 18% in 2024. In 2024, the share of...
In brief: Bid fight’s next phase, Numotion’s LMN Navigator, Apple’s new sleep feature
September 12, 2025HME News Staff
WASHINGTON - AAHomecare has budgeted more than $3 million for a campaign to address the restart of the competitive bidding program.
The association will draw the funds for the campaign from its reserves and new fundraising efforts. Already, VGM and 21 other AAHomecare members have pledged more than $750,000. AAHomecare will expand solicitation efforts in the coming weeks.
“If the bidding program starts up again using the flawed framework and expanded product mix...
In brief: Vent correction, Medtrade ‘Insider,’ documentation update
October 9, 2024HME News Staff
CAMBRIDGE, Mass. – Philips Respironics has issued a voluntary correction for Trilogy Evo, Trilogy Evo O2, Trilogy Evo Universal and Trilogy EV300 ventilators regarding the use of in-line nebulizers.
The company has determined that, in some circumstances, the use of in-line nebulizers placed in certain locations may lead to aerosol deposits forming over time on the ventilator flow sensor. Should this occur, there is a possibility of patient impact due to one or more of the following...
Noridian updates medical records requirements
October 7, 2024HME News Staff
WASHINGTON – In the event of a claim review, information contained directly in the contemporaneous medical record is the source required to justify payment, except as noted elsewhere for prescriptions, according to an update posted by Noridian Healthcare Solutions. The medical record is not limited to records from treating physician/practitioner offices but may include records from hospitals, nursing facilities, home health agencies and other health care professionals. Records from suppliers...