How a Nashville DME Supplier Reduced Unfulfilled Cases by 83% and Recovered $180K in Delayed Claims

Business: Home medical equipment and DME supplier, Nashville, Tennessee, United States. 18 staff including intake coordinators, delivery technicians and billing team. Primarily oxygen, CPAP, and mobility equipment, serving Medicare, Medicaid and commercial payer mix. The problem: Cases were tracked in a combination of a shared Excel workbook and paper intake forms. The billing team submitted claims based on delivery confirmations, which arrived from technicians via text message and were manually entered into the tracking spreadsheet. The process had three critical failure points: cases that were not delivered by the expected date had no automatic escalation, so they sat unresolved until a patient or referral source called. Rental billing cycles for CPAP and oxygen were tracked manually, with an estimated 12 percent of eligible rental bills not submitted in the month they were due due to tracking gaps. And when a Medicare audit request arrived in Q3, the billing team spent 3 days assembling documentation for 8 cases. documentation that should have been immediately accessible. The solution: Certiva DME Workflow Control deployed across the intake, delivery and billing teams. Each case is created at intake with the patient, referring physician, insurance and equipment details captured at the source. Delivery technicians confirm fulfillment in the mobile app with serial number scan and delivery photo. Rental billing cycles are automated with exception flags for status changes. The billing team works from a structured workflow queue rather than a shared spreadsheet. Every case document is stored against the case record and retrievable in seconds. The results: Unfulfilled equipment cases dropped from an average of 6 per month to 1 per month in the first quarter, an 83 percent reduction. The billing team identified $180,000 in previously unsubmitted or delayed claims in the first six months after deployment: rental bills that had not fired and claims delayed past timely filing deadlines that had not been flagged. By month six, the monthly revenue recovery from improved claim submission timing was approximately $24,000 compared to the same period the prior year. When a second Medicare audit arrived 5 months after deployment, the team produced complete documentation for all requested cases in under 8 minutes. Key takeaway: DME revenue leakage is a visibility and workflow problem. Cases do not get dropped intentionally. they get dropped because no one has a complete view of where each case stands. Certiva gives the whole team that view, from the moment a referral arrives through the final billing follow-up. Book a demo to see how Certiva DME Workflow Control maps to your case types, rental cycles and payer mix. Related reading: DME billing software for small suppliers covers what DME software must do to be worth deploying. Certiva vs. Brightree covers the comparison most SMB DME suppliers make when evaluating dedicated case management.