- October 16, 2026
- Posted by: Josh Knoll
- Category: DME Billing
Medicare generally pays for DME in its capped-rental category for up to 13 months of continuous use, after which the patient owns the equipment. But what happens if the patient changes insurance during the rental? The answer depends on the equipment, the previous coverage, and the new payer’s rules, and DME suppliers also need to check these details before submitting the next claim.
Also, while the patient may keep using the same hospital bed or wheelchair, the billing requirements can change. The new insurer may have different rules for approved suppliers, prior authorization, rental payments, and patient costs. Updating the insurance card is a start. In fact, the checks below can help a billing team prepare and ensure a seamless billing transaction.
1. Confirm the Coverage Dates
The date a patient provides a new insurance card may not be the date coverage started, and this often confuses many. Thus, verify when the new plan became effective and when the previous coverage ended.
Also check:
- The plan name and member ID
- The correct payer information for claim submission
- Whether the plan covers the rented equipment
- Which plan pays first if the patient has more than one policy
- Whether claims have already been submitted for the affected dates
If the insurance change falls within a rental billing period, check the payer’s instructions before submitting the claim. Do not assume the rental charge should be split between insurers. Keep the old insurance details available as the team may still need them to resolve earlier claims or respond to payment questions.
2. Check Whether You Are in the New Plan’s Network
Coverage for the equipment does not necessarily mean the patient can continue receiving it from the same supplier. Confirm whether your company participates in the patient’s specific plan. Also, do not forget that being contracted with an insurer does not always mean you participate in every plan it offers.
If you are out of network, ask about arrangements that could allow the existing rental to continue. Record the payer’s response and request written confirmation where possible. Medicare Advantage coordinated care plans must provide a transition period of at least 90 days for qualifying active treatment when a patient switches to a new plan. During that period, the new plan cannot require prior authorization for that treatment. Check how this protection applies to the patient’s DME rental rather than assuming every rental qualifies.
3. Review Prior Authorization Requirements
Do not assume the previous insurer’s approval will be accepted by the new plan. Check whether a new authorization is required or whether a transition arrangement applies. And also ask the payer:
- Does this item require authorization?
- How does the plan handle equipment already being rented?
- What records are needed?
- Which dates, equipment codes, and units does an approval cover?
- Does the approval identify a particular supplier?
Save each authorization with the issuing payer’s name and the dates it covers for a better understanding. For any DME pending requests, assign a staff member to follow up and set a review date. This not only helps prevent the request from being overlooked before the next billing cycle but also ensures seamless DME billing services.
4. Review the Rental History
Before choosing the next billing month, review the full account history. Check the original delivery date, equipment details, previous rental claims, payments, and any interruptions in use. Also confirm whether Original Medicare has previously paid rental claims for the item.
An insurance change does not always mean the rental restarts, and it does not always mean the old month count continues. For a patient entering Original Medicare with equipment previously rented under another insurer, Noridian explains that the existing item may qualify as a new initial Medicare rental when the applicable requirements are met. We also know coverage does not continue automatically simply because another insurer paid for it.
Equipment-specific rules also matter a lot when it comes to managing efficient DME billing services. A pause in billing alone does not necessarily create a new rental period. Oxygen has separate rules, so staff should not apply a hospital bed’s rental instructions to an oxygen concentrator.
| Insurance change | What to review |
|---|---|
| Commercial insurance to Original Medicare | Medicare eligibility, coverage requirements, documentation, and treatment of the first Medicare rental claim |
| One Medicare Advantage plan to another | Network participation, transition protections, and authorization requirements |
| Original Medicare to Medicare Advantage | The new plan’s rental policy, network requirements, and billing instructions |
| One commercial plan to another | The new insurer’s rules for an existing rental and previous rental months |
5. Check the Supporting Documents
The new insurer may need records supporting coverage even though the patient already has the equipment. Depending on the item and payer, review:
- The treating practitioner’s order
- Medical records showing why the equipment is needed
- Proof of delivery or possession
- Evidence of continued need or use, where required
- Equipment and accessory details
Patients entering Original Medicare with an existing rental may need specific documentation showing that the supplier examined the item and that it meets Medicare requirements. Thus, following the applicable instructions rather than relying only on the previous insurer’s records can be quite beneficial.
Keep the original documents unchanged and obtain missing information through the proper process. It is essential to never alter dates to make an account appear complete if you are looking for a successful DME billing business.
6. Confirm the DME Codes, Modifiers and all the Payment Rules
The equipment may stay the same while the payment rules change. So check for the right HCPCS code that correctly identifies the DME equipment to match the item supplied. Then review the required modifiers, which provide details such as rental status or the applicable rental month. Also, confirmation is part of the DME billing process, as it aids in checking the new payer’s allowed amount and whether accessories or supplies are paid separately.
7. Follow Up on the First DME Claim
To make things easy, you can set a follow-up date for the first claim sent to the new insurer to confirm when it was received, and ensure prompt responses to any requests for information. When the claim is processed, also check for:
- Whether the correct insurer handled it
- Whether the payment matches the applicable allowance
- Whether the rental month and modifiers were accepted
- Whether the same rental period was billed twice
- Whether future claims use the verified account settings
If the claim is rejected or denied, identify the cause before the next recurring claim goes out. Otherwise, the same error may repeat each month.
How Can SunKnowledge DME Billing Services Help
Insurance changes create extra work across eligibility checks, authorization follow-up, rental tracking, and claim review. When comparing durable medical equipment billing services, ask how the team handles these changes on active rental accounts. A DME medical billing company should be able to explain how it keeps previous records, verifies new requirements, and follows unresolved issues. SunKnowledge’s DME billing services include eligibility verification, authorization follow-up, claim submission, payment posting, and accounts receivable follow-up. Taking care of all complex billing work at $7 an hour, our experts in fact offer after-sales support for CPAP too.
If insurance changes are leaving rental accounts unresolved, contact SunKnowledge to discuss support for your billing workflow.
FAQs
Does the rental period restart when insurance changes?
Not true in many cases because the answer depends on the DME equipment, payer, and coverage history. Thus, review the applicable rules before changing the rental month in the billing system.
Does it affect the prior authorization?
It mainly depends on the patient’s insurance plan, and with the right DME billing team, you no longer have to worry about anything, whether it’s authorization, claims follow-ups, or more.
What if the DME supplier is outside the new network?
Being one of the most common concern among many DME providers, a DME suppliers when is outside the new network can look into the plan to discuss and work out continuity of care or other available arrangements. If another supplier takes over, coordinate the transition and clarify billing responsibilities.