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Bookkeeping for DME and HME suppliers: how LedgerBPO runs it
LedgerBPO provides bookkeeping for DME & HME suppliers: a named, dedicated accountant who posts Brightree or Bonafide billing activity to QuickBooks Online or Sage Intacct, matches Medicare and commercial remittances to bank deposits, tracks capped-rental revenue month by month and closes the books on a fixed schedule with a second-accountant review. You keep your software, your bank access and your billing team.
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What we handle
LedgerBPO provides bookkeeping for DME & HME suppliers: a named, dedicated accountant who posts Brightree or Bonafide billing activity to QuickBooks Online or Sage Intacct, matches Medicare and commercial remittances to bank deposits, tracks capped-rental revenue month by month and closes the books on a fixed schedule with a second-accountant review. You keep your software, your bank access and your billing team.
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Billing and books together
Rental, sale and resupply revenue tracked by product line and payer
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Reconciled every month
Brightree, Bonafide or TIMS activity tied to the general ledger every month
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What you see
Patient balances and payer remittances matched, aged and followed up under your brand
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A named accountant, a backup and a team lead
Inside your own software, on a fixed close calendar, with a reply from a person within 1 business day. Call +1-657-777-0006 or start a quote.
Book a billing audit 06 / 06
· Reviewed by Nimra Khalid
DME & HME accounting challenges
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Rental revenue arrives in pieces
Medicare pays capped-rental items such as hospital beds and standard wheelchairs across 13 monthly claims, and oxygen equipment across a 36-month rental period before payments stop. Every one of those months is a separate remittance line that has to land against the right patient, item and period.
- 02
Patient balances are small and slow
After the Part B deductible, Medicare beneficiaries owe 20 percent coinsurance on covered DMEPOS, so one rental creates a long chain of small patient statements. Those balances age quietly unless someone works them on a fixed weekly cadence.
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Prior authorization holds up cash
CMS requires prior authorization before certain power mobility devices, pressure-reducing support surfaces and lower-limb prosthetics can be billed, so delivered orders wait in Brightree until the decision returns. Revenue belongs to the delivery month while the cash arrives weeks later, which makes an unreviewed P&L misleading.
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Competitive bidding and fee schedules move margins
Under the Medicare DMEPOS Competitive Bidding Program, single payment amounts replaced the fee schedule in bid areas, and rural and non-rural rates can differ for the same HCPCS code. Cost of goods has to be tracked by product line, not in one bucket, to see which lines still earn a margin.
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Inventory lives in patients' homes
Rental fleets, serialized concentrators and resupply stock sit on the balance sheet but not on the shelf, and PAP resupply programs ship to each patient on Medicare's replacement schedule, roughly every 90 days for masks and cushions. If Brightree and the ledger count differently, the balance sheet and the P&L are both wrong.
What we handle for DME and HME suppliers
Billing-system activity posted to the ledger
Your accountant pulls the monthly revenue, adjustment and cash-posting summaries from Brightree, Bonafide or TIMS and posts them to QuickBooks Online or Sage Intacct by payer class and product line. The billing system stays the source of patient detail; the ledger carries the totals.
Remittances matched to deposits
Medicare EFTs from your DME MAC, commercial ERAs, Medicaid warrants and patient card payments are matched to bank deposits under our ReconBot workflow. Anything that does not tie out goes on an exception log with a name against it.
Rental revenue schedules
Capped-rental and oxygen rentals are tracked on a schedule so month 13 and month 36 do not surprise anyone. Deferred and unbilled amounts are reviewed at every close.
Patient statements under your brand
Our BillingLine desk sends statements and takes patient billing calls under your company name, following the DunningDesk cadence you approve. Agents never store card data; patients pay through your portal.
Inventory and cost of goods by product line
Respiratory, mobility, sleep resupply and retail lines each carry their own revenue and cost accounts so gross margin is visible per line. Rental fleet depreciation is booked monthly, not at year end.
One team for claims and books
Where the claims side is handled by our sister brand SS Support Network, the same team lead reconciles billed, adjusted and collected figures against the ledger. Every close goes through Two-Tier Review before you see it.
DME & HME software we work in
- QuickBooks Online
- Sage Intacct
- Bill.com
- Gusto
- Brightree
- Bonafide
- TIMS Software
- All 50 platforms
DME & HME compliance notes
Medicare DMEPOS supplier rules
Medicare DMEPOS suppliers must meet the supplier standards, hold accreditation and keep a surety bond to bill Medicare. Payment then follows fee schedules, competitive-bid amounts and capped-rental rules that decide when revenue is earned. Your books need to reflect those payment rules, not a generic sales model.
Prior authorization
CMS keeps a Required Prior Authorization List for certain DMEPOS items, and claims for those items without an affirmed decision are denied. We flag delivered-but-unauthorized orders as unbilled at each close so cash forecasts stay honest. Authorization work itself stays with your intake or billing team.
HIPAA
Patient names and diagnoses appear on remittances, statements and Brightree exports. Our staff are HIPAA-trained, we sign a BAA, access is logged and files are never downloaded to local devices.
State sales tax on equipment
Many states exempt prescribed durable medical equipment from sales tax while taxing retail accessories and over-the-counter items. We track taxable and exempt sales separately in the ledger so returns can be prepared from the books. Your tax preparer or advisor confirms the rules for each state.
KPIs we report
| KPI | Why it matters |
|---|---|
| Days from delivery to claim or invoice | Every day an order sits unbilled after delivery delays the first rental payment and the whole chain that follows. |
| Rental claims billed versus rental claims due in the month | Missed rental months are revenue that is rarely recovered once timely-filing windows pass. |
| Patient AR over 90 days as a share of total patient AR | Small coinsurance balances become uncollectable quickly, so the trend matters more than the total. |
| Inventory variance between billing system and ledger | A rising gap points to unposted deliveries, lost rental equipment or a costing problem. |
| Books closed within five business days of month-end | Lenders, owners and your billing manager all need the same numbers early in the month. |
Services for DME and HME suppliers
- Outsourced bookkeeping for dme & hme suppliers
- Invoicing & billing for dme & hme suppliers
- Accounts receivable management for dme & hme suppliers
- Accounts payable processing for dme & hme suppliers
- Bank & credit-card reconciliation for dme & hme suppliers
- Month-end close for dme & hme suppliers
- Monthly financial reporting for dme & hme suppliers
- Catch-up bookkeeping for dme & hme suppliers
- Payroll processing support for dme & hme suppliers
- Cash application & remittance posting for dme & hme suppliers
- Payment processor & marketplace reconciliation for dme & hme suppliers
- KPI dashboards for dme & hme suppliers
- Remote controller review for dme & hme suppliers
- Accounting software setup & migration for dme & hme suppliers
Frequently asked questions
Do you do DME claims billing or just the books?
LedgerBPO handles the books, patient statements and the reconciliation of billing-system activity to the ledger. Claims submission, denials and prior authorization follow-up sit with your billing team or with our sister brand SS Support Network, which offers DME billing services. When both sides are with us, one team lead reconciles claims data against the ledger every month.
Can you work inside Brightree?
Yes, for reporting and exports. We use Brightree's revenue, adjustment, cash and AR aging reports to post to the ledger and to reconcile against bank deposits. We do not change patient records, orders or claim data. The same approach applies to Bonafide, TIMS and other HME billing platforms with standard reports.
How do you record capped-rental revenue?
Each rental item is placed on a schedule that shows the rental month, the expected payment and the cap. Revenue is recognized as each rental month is billed, and the schedule is reconciled to Brightree at every close. This makes month-13 conversions and 36-month oxygen caps visible ahead of time rather than as a surprise drop in revenue.
How do you handle patient coinsurance balances?
Patient balances are aged separately from payer balances and worked on a fixed cadence through our DunningDesk process. Statements and reminder calls go out under your brand from our BillingLine desk, using your approved wording. Agents never take card numbers; patients pay through your portal or by mailing a check to your lockbox.
What does the month-end package include for an HME supplier?
You receive a P&L by product line and location, a balance sheet with a reconciled inventory and AR position, a rental revenue schedule, a payer-mix summary and a short note on what changed. Our month-end close service page describes the CloseTrack checklist and sign-off log behind each package.
Is patient data safe with a remote accounting team?
Yes. Staff are HIPAA-trained, we sign a BAA, every login uses MFA, and access to Brightree and your bank feeds is read-only where possible. Remittance files and statements are handled inside your systems and our LedgerDesk portal, never on local drives. Our security page lists the full control set.
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