Two DME suppliers with identical order volume can earn very different revenue, because what you net per setup depends on your payer contracts, your HCPCS mix, write-offs, and how much patient responsibility you actually collect. The list price on an E0601 PAP device or a K0823 power wheelchair means little; the net reimbursement after the allowed amount, the write-off, and the patient balance is the number that pays the business. This dashboard shows what each setup and item truly nets, and where it leaks.
What this report answers
What do we actually net per setup, by payer and by item, and where does the allowed amount slip away? The reimbursement-by-payer page shows total net reimbursement, net per setup, allowed realization rate, and write-off dollars, with net-per-setup and total net by payer and a payer-level table. The item-economics page adds patient-responsibility collection and units reimbursed, with net-per-setup by HCPCS group (PAP device, mask, oxygen concentrator, power wheelchair, orthotic, diabetic supplies, hospital bed), net vs. write-off by product category, and patient-collected rate by payer.
The metrics that matter
Net reimbursement per setup (net ÷ setups) is the headline economic unit — it normalizes revenue across payers and items so a high-volume, low-net payer can't hide. Allowed realization rate (net ÷ allowed) shows how much of the contractually allowed amount you actually banked; a gap means write-offs or uncollected patient balances. Write-off dollars and patient responsibility collected rate are the two leaks that erode realization — the first often avoidable, the second a front-desk and statement-process issue. Units reimbursed anchors volume.
Why the data is trapped
Billed, allowed, paid, write-off, and patient-responsibility amounts live across the claim, the remittance, and the patient-pay ledger inside Brightree, Bonafide, WellSky DME, or Computers Unlimited's TIMS. Most platforms report gross billed and total paid, but computing a true net-per-setup by HCPCS group — net of write-offs and including patient collection — requires joining those layers and dividing by the right denominator. That's the modeling work that turns "we billed a lot" into "this item at this payer nets us X."
How to read it
Rank payers by net per setup, not by volume — the payer driving the most claims may net the least per setup. A low allowed realization rate points at write-offs or uncollected patient balances; the write-off-vs-net stacked bar shows which product categories bleed. Net-per-setup by HCPCS group is your item-economics map — it tells you which lines carry margin and which barely cover cost. Patient-collected rate by payer flags where high-deductible plans leave balances unpaid. This sample uses fully synthetic line items — no PHI.
Metrics it tracks
| Metric | What it means |
|---|---|
| Total Net Reimbursement | Net dollars collected across paid line items — SUM(NetReimbursement). |
| Net Reimbursement per Setup | Net dollars over number of setups — SUM(NetReimbursement) ÷ SUM(SetupFlag). |
| Allowed Realization Rate | Net collected over contractually allowed — SUM(NetReimbursement) ÷ SUM(AllowedAmount). |
| Patient Responsibility Collected Rate | Patient portion actually collected — SUM(PatientCollected) ÷ SUM(PatientResponsibility). |
| Write-Off Dollars | Total written off across line items — SUM(WriteOffAmount). |
| Units Reimbursed | Total service units paid — SUM(Units). |
Used by: DME/HME owner; billing & ops director
Frequently asked questions
What is net reimbursement per setup in DME?
It's total net dollars collected divided by the number of completed setups — the true revenue earned per equipment setup after the allowed amount, write-offs, and patient responsibility are accounted for. It normalizes revenue across payers and HCPCS items so you can compare them on the same footing instead of by gross billed dollars.
What is allowed realization rate and why track it?
Allowed realization rate is net reimbursement divided by the contractually allowed amount — how much of what your contract permits you actually banked. A gap below 100% means write-offs or uncollected patient balances are eroding revenue you were entitled to, which is usually a recoverable, fixable leak.
Why track patient-responsibility collection separately?
As plans shift more cost to patients through deductibles and coinsurance, the patient portion is a growing share of DME revenue — and it's collected very differently from insurance. A low patient-collected rate points at front-desk collection and statement processes rather than payer behavior, so it needs its own metric and its own fix.
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