Improve ROI with Streamlined HME Prior Authorization

Becoming effective on Jan1 2021 and extending through Dec 31st 2023, with a product category of 16 with newly included items like (OTS) back braces, knee braces, and non-invasive ventilators, CMS is implementing the lead item methodology for all product categories. It essentially implies that rather than submitting individual bids, bidders will only submit one bid for the lead item in the product category. The SPA for an item in the lead is the max bid submitted by the bidders for that item whose bids are in range of winning for that CPA and combination of product category.

All bidders in Round 2021 are required to obtain a bid surety bond in the amount of $50,000 for each CBA in which they submit a bid. Each location of a supplier on a bid must have accreditation from a CMS approved organization for the non lead and lead items in a product category. Any supplier interest to bid for a product category without having its location accredited for the product category must take the necessary action to get it accredited.

The Sunknowledge Answer in HME Prior Authorization

Ability to offer both pre as well as post billing support, Sunknowledge Services Inc has the perfect answer for all heavy lifting work. Our team performs task specific functions in HME prior authorization, eligibility verification, denial management and accounts receivable collections. We do all the work that includes HME order entry, confirmation, and doctor's office follow up and collections and indexing of documents unlike any other healthcare RCM company.

HME Prior Authorization

Pre Billing

  • Order Entry
  • Eligibility Verification and Authorization
  • Doctor Office Follow-up
  • Order Confirmation
  • Scheduling of Delivery

Billing and Collections

  • Creation of Claims
  • Claims Submission & Rejections
  • Cash Posting
  • A/R Follow-up
  • Rejection & Denial Management

Let us work as your ultimate operational extension! Sunknowledge Services Inc has the ability to offer you a holistic support unlike any other HME billing and collections company. Let us share with you, our best practices with you for an improved cash flow in the best possible manner.