DME billing services for HME and DME suppliers
Actigy BPO checks documentation for durable medical equipment (DME) and home medical equipment (HME) suppliers before claim submission.
Actigy BPO provides DME billing services for suppliers and billing companies through nearshore business process outsourcing (BPO) teams. Operators in Bulgaria, Romania, Poland and Ukraine check order records, prepare claims and manage unpaid-claim follow-up in client systems. The supplier retains clinical and payer-contract decisions. The process audit and paid pilot test a defined equipment-billing queue.
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Key takeaways
Actigy BPO adds operating capacity to a supplier's existing billing process.
- Actigy BPO delivers from teams in Bulgaria, Romania, Poland and Ukraine.
- Every Actigy BPO engagement starts with a process audit and a paid pilot.
- Documentation checks identify missing records; the supplier resolves clinical questions.
- Rental and purchase queues follow the client's approved billing instructions.
- Payer responses and unresolved balances remain visible in the client's system.
DME billing at a glance
Actigy BPO defines the equipment queues, document access and client reviewers before work starts.
| Field | Actigy BPO service |
|---|---|
| Service | Intake checks, claim preparation, denials and accounts receivable (AR) follow-up. |
| Buyer | HME and DME suppliers and billing companies. |
| Delivery | Bulgaria, Romania, Poland and Ukraine. The first 3 locations are EU hubs. |
| Coverage | Contracted shifts; calls to US payers run in their business hours. |
| Pricing | Per full-time equivalent (FTE) by role; written quote after the process audit. |
| Start | Paid pilot; timing depends on access, training and scope approval. |
DME billing services: documentation and claims
Actigy BPO checks each assigned record against the supplier's approved checklist. The team records missing information before preparing the next action. Durable medical equipment billing links orders, records, billing periods and payer responses.
| Workstream | Actigy BPO output | Supplier responsibility |
|---|---|---|
| Order intake | Missing-field list and assigned follow-up owner. | Provide and approve the source records. |
| Documentation | Completeness record for requested order and delivery documents. | Resolve clinical questions and documentation validity. |
| Claim preparation | Prepared claim checked against approved instructions. | Retain coding policy and submission authority. |
| Rental or purchase | Recorded billing period, order type and unresolved discrepancies. | Confirm the applicable payer and equipment rules. |
| Denials | Reason, evidence, proposed action and deadline. | Approve actions outside the written procedure. |
| Unpaid balances | Status notes and next steps for assigned AR. | Approve adjustments, write-offs and refunds. |
Actigy BPO routes prior-authorization questions and requests for clinical documents to the supplier. A rejection occurs before adjudication; a denial follows payer review. Operators record these as different outcomes. The denial management services page explains the denied-claim workflow.
The CMS documentation guidance identifies Medicare record requirements. The supplier confirms the applicable rules for each equipment and payer queue. This service description is not a Medicare billing manual.
How Actigy BPO starts the billing process
Actigy BPO starts with a process audit that traces an assigned claim from intake to the recorded payer outcome. The team checks access, missing-document routes and approval responsibilities. A standard operating procedure (SOP) then defines allowed actions, exceptions and the evidence required for review.
- Review the queue. Group records by payer, age, equipment workflow and missing information.
- Define the procedure. Agree required fields, ownership, review steps and escalation deadlines.
- Prepare the team. Train operators on client instructions and approved system access.
- Run a paid pilot. Test a bounded queue and review its completed work with the client.
- Review quality. Use maker-checker quality assurance (QA) and sampled checks to record errors and corrections.
- Expand approved work. Add volume only after the agreed pilot thresholds are met.
- Update the procedure. Record approved changes when a recurring issue or payer requirement changes.
Actigy BPO keeps a record's latest action, owner and next review date in the client's system. At handover, unresolved items retain their evidence and status. An operator leaving the queue does not close its unfinished claims.
Measures the supplier can audit
Actigy BPO agrees each key performance indicator (KPI) with the supplier before the pilot. Definitions state the reporting period, included records and exclusions. Counts of claims touched are separate from claims paid. No collection percentage or DME performance target is promised on this page.
| Measure | Definition to agree |
|---|---|
| Clean claim rate | Claims accepted without a correction request, divided by the submitted claims in the agreed group. |
| Documentation-related denials | Denied claims with a recorded documentation cause, with the denominator and reporting period stated. |
| Days in AR | Receivable days calculated from the agreed balance and revenue records using a consistent method. |
| Open document requests | Unresolved requests grouped by age and the party responsible for supplying each item. |
Reports separate missing documents, pending payer responses and entry errors.
Risks, controls and decisions you keep
Actigy BPO links each billing risk to a documented control. A mismatched order goes back to its owner. An uncertain rental period pauses the affected claim for review. Missing proof remains an open exception, not an assumed complete record.
Actigy BPO prepares claims and appeals; the provider keeps clinical, coding and payer-contract decisions. The team does not determine medical necessity, approve treatment or change payer terms. The client approves refunds, adjustments and write-offs. Operators do not release payments or move money.
Rental and purchase queues
Actigy BPO records the client's approved billing periods and distinguishes rental from purchase work. Operators compare submitted periods with source records and flag duplicates or gaps. Equipment-specific rules come from the supplier's approved instructions. No universal rental length or reimbursement rule applies to every queue.
Patient records and access
Actigy BPO works on protected health information (PHI) only in the systems the client approves. Access is limited by role. Logs and review records support investigation of an incorrect action. The written scope defines work locations, subprocessors and transfer terms.
Data handling for US healthcare clients, including HIPAA requirements, is agreed in the written scope and data processing terms. The client confirms any payer restrictions on offshore data access before the pilot. Restricted queues stay outside the scope. Review the data-processing terms before sharing records.
Coverage and pricing
Actigy BPO teams in Central and Eastern Europe cover the full UK business day and the US morning. Calls to US payers run in US business hours. Later calls require an agreed shift. Written coverage terms identify the queue owner and escalation contact; 24/7 delivery is not automatic.
Actigy BPO delivers from EU hubs in Bulgaria, Romania and Poland, and from Ukraine. Ukraine is outside the EU. The client confirms approved work locations before access starts.
Actigy BPO prices most services per full-time equivalent (FTE) by role and sends a written quote after the process audit. The quote identifies staffing, review time, training and coverage. Software charges and client-retained work remain part of the buyer's cost comparison. No percentage-of-collections price is implied.
Compare the outsourcing pricing models before choosing a billing engagement. A small irregular queue can cost less to retain internally than to staff as a dedicated external process.
Compare DME billing delivery models
Actigy BPO runs the agreed workflow and its review process under the managed model. An in-house team retains daily management inside the supplier. An individual contractor provides the contracted work; the buyer must check how review, absence and replacement are covered.
| Responsibility | Actigy BPO managed team | In-house team | Freelancer or staffing agency |
|---|---|---|---|
| Daily workflow | Managed within written scope. | Managed by the supplier. | Defined in the individual contract. |
| Quality review | Documented review and QA sampling. | Client designs and runs review. | Check whether review is included. |
| Decisions | Client retains clinical and financial approvals. | Client retains approvals. | Client retains approvals. |
| Tools and records | Client-approved billing systems. | Client-selected systems. | Access and record ownership need agreement. |
| Price comparison | Quoted FTE scope and retained client costs. | Pay, recruitment, training and supervision. | Contract fee plus retained supervision. |
When Actigy BPO fits DME suppliers
Actigy BPO fits when a supplier needs a managed documentation and claims queue inside its existing billing system. The supplier has approved procedures and a reviewer for exceptions.
Actigy BPO is not the right fit when payer terms prohibit offshore access or the buyer needs clinical decisions instead of administrative work.
How do you compare DME billing companies?
Actigy BPO offers a managed workflow, so compare suppliers on scope, records and decision ownership rather than an unverified collection promise. Ask for the proposed queue map, access controls and sample reporting fields. A useful pilot shows which records were checked, which issues remain and who must act next.
When does it help to outsource HME billing?
Actigy BPO fits HME suppliers with recurring documentation follow-up, unpaid claims or capacity gaps that an agreed operating team can manage. Check the source records and client reviewer capacity first. Outsourcing a queue does not resolve missing clinical evidence or remove the supplier's responsibility for its payer requirements.
What fits DME billing for small suppliers?
Actigy BPO assesses whether a small supplier has enough stable work for the proposed staffing model. Start with one defined queue and compare its total cost with internal delivery. A low-volume business without approved procedures or regular review capacity may need to keep the work in-house until the scope is viable.
DME billing questions
Actigy BPO answers these questions for suppliers buying billing support, not patients seeking equipment coverage.
What do DME billing services include?
DME billing services cover administrative work that prepares, submits and tracks equipment claims. Actigy BPO provides order and documentation checks, claims support, denial work and AR follow-up within the agreed scope. Operators use the client's billing system and record unresolved issues. The supplier retains clinical documentation, coding policy and payer-contract decisions. The process audit identifies the exact equipment queues, source records and actions the team can perform.
Why do DME claims get denied?
Actigy BPO reviews the payer's stated reason before proposing a denial action. Missing documentation, inconsistent claim data or an unresolved coverage requirement can require different responses. The team requests missing administrative records or routes a clinical question to the supplier. A rejection before adjudication is tracked separately from a denial. The supplier confirms the applicable payer rules and approves actions that fall outside the written procedure.
Can a team outside the US bill for US DME suppliers?
Actigy BPO can provide administrative billing support from the agreed delivery locations when the client's contracts and access rules permit it. The client checks payer and government-program restrictions before patient records become accessible. Calls to US payers require US-business-hour coverage in the written scope. A supplier retains coding, clinical and contract decisions. An offshore team is not a workaround for a restriction on where records can be handled.
Who keeps documentation and compliance decisions?
The supplier retains documentation validity, clinical decisions and responsibility for its applicable requirements. Actigy BPO checks completeness against client-approved instructions and routes missing or inconsistent records to the named owner. Operators do not decide medical necessity or alter source clinical evidence. The client also approves refunds, write-offs and adjustments. Record access, work locations, review steps and escalation responsibilities belong in the written scope before the paid pilot starts.
How are DME billing services priced?
Actigy BPO quotes DME billing services per FTE by role after the process audit. The quote depends on the assigned queues, document follow-up, review requirements, client tools and coverage hours. Compare included supervision and training as well as the staffing fee. The supplier still provides approvals and source information. A paid pilot tests the agreed workload before expansion; this page does not promise a collections percentage or a fixed saving.
Related billing services
Actigy BPO can connect equipment billing to a wider medical billing outsourcing scope. Use insurance verification services for coverage checks and payment posting for recording remittances. Map the handoffs through revenue cycle management outsourcing and AR follow-up.
Plan a DME billing pilot
Actigy BPO needs a description of the queue, approximate volume, client system and required coverage to scope the next step. Use the form below for business information only. Do not upload patient records or clinical documents. Protected records enter approved systems only after access and processing terms are agreed.
Page updates
Actigy BPO published this service guide on October 4, 2026, with scope, controls and buyer questions.
Scope a pilot
What happens next
The team reviews the workflow before proposing a written scope. You decide whether to start a paid pilot after reviewing it.