DME Medical Necessity and Adherence Documentation demo
A 30-night window slides across 90 nights of CPAP data and the visit note is checked against days 31 to 91, so a short month is found before billing. 1:30
What the demo shows
A documentation check for DME billing teams: CPAP and wound pump months proven before billing
Agents read 640 claim files: 479 are ready and 161 are not, each with its reason. On CPAP file HC-CP-24817 they find nights 18 to 47 with 22 of the 21 nights needed, but the visit came on day 97. The billing specialist holds the month and signs; the intake coordinator asks the practice for any visit in the window; a sampled release and a second signature send the ready files to billing.
Transcript
- DME Medical Necessity and Adherence Documentation checks CPAP and wound pump claims for billing teams.
- In 2025, Medicare found 10.6 percent of CPAP payments improper.
- The window finds nights 18 to 47: 22 good nights, all before the visit.
- But the visit came on day 97: not ready, with the rule cited.
- Calixta opens the visit note herself before deciding.
- She holds month four, so it is not billed on a guess, and signs with her own password.
- The intake coordinator asks the practice for any visit between August 7 and October 6.
- A write-off posts only after a second person, the revenue cycle manager, opens it, reads it, and signs with her own password.
- Every decision and signature lands in the audit trail.
- Across 640 files, 479 are ready and 161 carry a reason and an owner.
- Built on Botminds: agents, data, screens and governance on one platform.
The narration as written for the film. Captions are on the player.