Smart Talk

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....

Q: With the new ventilation NCD placing greater emphasis on clinical involvement, how should providers think about reimbursement and their relationships with referral sources moving forward? A: The new NCD is changing more than reimbursement requirements. It's changing how providers are viewed within the patient care continuum. Historically, some referral sources may have viewed the provider's role as largely transactional: delivering equipment, providing setup and managing fulfillment....

Q. How can DME suppliers mitigate legal risks associated with telehealth arrangements? A. As telehealth technologies have become more widely used and accepted as a means of delivering health care services, regulators have increased their scrutiny of arrangements involving these services. Although the enforcement landscape continues to evolve as novel telehealth models and related fraud schemes emerge, DME suppliers can help mitigate legal risk by learning from the compliance concerns highlighted...

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,...

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...

Q. How can DMEPOS suppliers prepare for new compliance requirements that may arise from the CRUSH Request for Information? A. In early 2026, CMS issued a Request for Information (RFI) to solicit recommendations and information from industry participants and other stakeholders to bolster the Trump administration’s Comprehensive Regulations to Uncover Suspicious Healthcare (“CRUSH”) initiative. The CRUSH RFI sought input “…on ways to strengthen CMS’s ability...

Q. Am I coaching my reps or correcting them? A. Most of the time, it’s correcting. This manifests when the sales leader “takes over” calls when they see the rep have a misstep, or while debriefing a call they list what the rep should have said instead. This is reactive and directive behavior. And it’s probably just a reflection of how they were “coached” themselves. The job as coach is to change the behavior of the rep over time through learning, measured...

Q. How do I work with payers to resolve billing issues? A. Getting billing issues resolved with payers isn't about who complains loudest – it's about who shows up prepared. A little homework upfront turns a frustrating back-and-forth into a productive conversation. Know your contract Before reaching out, review your payer agreement for denial and appeal rights, filing deadlines and required documentation. Timelines vary by plan type and can be short, so missing a window can...

Q: I keep hearing about AI search and answer engines. What does that actually mean for how patients and referral sources find my CGM business? A: Most people are familiar with search engine optimization (SEO), the practice of making your website show up in Google search results. There is a newer concept worth understanding: AEO, or answer engine optimization. For CGM providers, it is quickly becoming just as important. Here is the difference. When someone types a question into Google, they...

Q. Why do my reps keep visiting accounts that never grow? A. They spend more time with these accounts because the fear of loss is greater than a potential reward. This fear compounds when the rep is on commission. They may protect their income and the “cash cow” feeding it. They don’t ask for additional lines of business because “it would risk my relationship.” It’s a productive account, but it doesn’t require this much time. Territory reps get sucked...