Answer Summary “Mostly complete” applications are automatically rejected because payers treat missing Third-Party Administrator (TPA) or roster details as non-compliant, leading to a 35% failure rate that stalls revenue growth. Transitioning to digital submission portals with “hard gates” is the…
Answer Summary: DME owners often assume that updating an address or changing ownership (CHOW) in PECOS is a quick online edit. In reality, a “Change of Information” (CHOI) triggers a 45–90 day review cycle by the MAC. During this time,…
Answer Summary: Orthotics & Prosthetics (O&P) is facing a credentialing crackdown. Payers like Blue Cross and UHC are now distinguishing between “Off-the-Shelf” (OTS) and “Custom Fitted” orthotics. If your accreditation only covers “DME Supply,” you may be locked out of…
Answer Summary: A common error for new DME providers is confusing Type 1 (Individual) and Type 2 (Organization) National Provider Identifiers (NPIs). You cannot bill Medicare for DME using a Type 1 NPI (like a doctor’s personal ID). You must…
Answer Summary: Before the 2026 Competitive Bidding window opens, CMS contractors (NSC/NPE West/East) will conduct unannounced site visits to verify that bidding locations are operational. These auditors strictly enforce the 30 Supplier Standards. Common failures include missing hours of operation…
