VGM Playbook: Building a Smarter, Stronger Business

VGM Playbook:

Building a Smarter, Stronger Business .

PAYER RELATIONS, EDUCATION,

RISK MANAGEMENT

Contract Management Strategies for Sustainable Payer Relations

By

Melanie Ewald, VP of Payer Relations and Reimbursement, VGM Group, Inc.

Beyond the Checkbox: How Education Builds Sustainable Compliance in HME

Jill Blaser, Senior Director of VGM Education, VGM & Associates

Auto Fleet Risk Management: A Non-Negotiable for the Future of HME

Connor Bravard, Regional Sales Producer, VGM Insurance Services

Optimizing Your DME for the Future:

a Strong, Compliant, and Audit-Ready Organization

Kelly

Letter From the President

This is a challenging time to be a home‑based care provider. The pace of change feels constant, planning feels harder, and the responsibility you carry for your teams, your patients, and your communities feels heavier than ever.

“VGM Playbook: Building a Smarter, Stronger Business” is designed to help you step back and take an honest look at how your business operates today and how it needs to evolve for the future. Inside, you’ll find practical guidance to streamline workflows, reduce inefficiencies, and better align your people, processes, and systems. You’ll also explore how data and market insight can bring clarity to growth decisions, helping you focus energy and resources where they matter most.

We also address technology and digital transformation, not as trends to chase, but as business decisions that should support efficiency, compliance, patient engagement, and long‑term stability. Alongside that, the playbook underscores the importance of education, payer relations, and risk management as foundations that protect your business and strengthen resilience over time.

Our goal with this playbook is simple: to give you clear, practical insight you can use right now, so you can move forward with confidence and intention, even as the industry continues to shift.

Thank you for the work you do and for being part of the VGM community. We’re here to support you as you build a smarter, stronger business for the future.

Sincerely,

Lindy Tentinger, President VGM & Associates

Lindy.Tentinger@vgm.com

A Data Strategy & Business Development Guide for DME Businesses

By Tyler Coulander, Market Strategy Manager, VGM & Associates

Data has quietly become a valuable competitive advantage in the DME industry. Rather than simply being reviewed at the end of the month, data should be used to guide the way DME organizations grow, compete, and make strategic decisions. Those who use data intentionally are shaping their markets. Those who don’t are stuck reacting to changes as they come.

Data is no longer a reporting function. It is the backbone of business development.

The good news is that DME businesses don’t need perfect data or a massive analytics team to get started.

Let’s outline how DME organizations can operationalize data across product strategy, sales, payer contracting, and health system partnerships to drive sustainable growth. The message is simple: Data is no longer a reporting function. It is the backbone of business development.

The Macro Case for a Data-Led DME Strategy

The DME industry is entering a sustained growth cycle, but not all growth will be evenly distributed.

CMS projections show DMEPOS spend growing from roughly $50B in 2026 to nearly $78B by 2033, representing a 6% CAGR. More importantly, volume‑based indicators suggest demand growth outpacing hospitals and skilled nursing facilities as care continues migrating into the home.

For DME leaders, this creates an opportunity: there is real growth, but significantly more competition for it. Data is what allows organizations to answer the most important strategic questions:

• Where is demand occurring?

• Which product categories are insulated (or exposed) to reimbursement risk?

• Which referral partners and payers are aligned with your operating model?

Without data, growth is reactive. With data, growth is deliberate.

Product & Segment Strategy Outlook

Not all DME categories are created equal. A data‑driven product strategy allows leaders to allocate capital and attention where risk adjusted returns are highest.

• Sleep therapy continues to show 6–8% growth, driven by obesity trends and improved resupply processes. Despite market noise around GLP‑1 drugs, CPAP demand remains resilient given cost, adherence challenges, and long‑term therapy realities.

A Data Strategy & Business Development Guide for DME Businesses

continued...

• Diabetes care/CGMs represent one of the fastest growing categories (~9.5% CAGR) but comes with heightened risk: competitive bidding exposure, pharmacy channel migration, and payer pressure demand constant monitoring.

• Oxygen therapy is steady (~4% CAGR) and relatively derisked following the end of competitive bidding. Portable oxygen concentrators are the primary growth engine.

• Complex rehab technology (CRT) benefits from favorable policy dynamics, including CMS coverage for seat elevation, modest growth, and insulation from competitive bidding.

Use this data to move past what’s popular and toward what’s actually sustainable for your specific business.

Localizing Strategy with Market Data

National trends are only the starting point. The real advantage emerges when providers localize these insights:

• HCPCS level utilization by geography

• Supplier density and local market share

• Referring provider’s concentration

Key sources for this information include VGM Market Data, CMS data portals (utilization, supplier, and referrer datasets), and targeted FOIA requests. The objective is not more data; it’s decision-grade data that clearly informs where to invest and where to avoid risk.

VGM Playbook: Building a Smarter, Stronger Business.

A Data Strategy & Business Development Guide for DME Businesses continued...

Sales Strategy: Precision Over Coverage

Most DME providers already have untapped growth potential due to misallocated sales efforts.

Referral volume is rarely evenly distributed. Organizations are often surprised by:

• Who their highest‑volume referrers are

• Which competitors those referrers are also using

• Key payer mix changes

Data enables sales leaders to tier referral sources based on opportunity, align compensation models to high value behavior, and avoid overinvestment in lower yielding accounts. With directional data, the sales strategy becomes less about coverage and more about execution.

care. Data can help reveal who to call but also what problem you could help solve for them.

Don’t Ignore the Data You Already Own

Align internal and external data to improve pricing strategy and operations.

VGM Playbook: Building a Smarter, Stronger Business.

Effective sales strategies also account for how referral partners get paid. Fee for service environments reward throughput, while shared risk and value based models are more focused on outcomes, readmissions, and total cost of

Some of the most powerful insights when it comes to data strategy and business development already exist within your organization. This includes billing and ERP data (utilization, collections, DSO), procurement data, and inventory management data. When you can effectively align internal and external data, this constantly improves pricing strategy and operations.

Turning Strategy into Reality

A data strategy without execution is meaningless. Sustainable advantage comes from a repeatable operational framework.

1 Define clear objectives

2 Collect relevant data

3 Analyze and validate insights

4 Identify the metrics that matter

5 Embed data into culture and incentives

6 Implement

7 Monitor

8 Adjust and optimize

Data strategy is no longer optional for DME providers. It is the foundation of business development, growth, and long term resilience. As the industry evolves, the separating line will become clear: organizations that use data to shape the market versus those that simply react to it.

About the Author

Tyler Coulander is the Market Strategy Manager for VGM & Associates. In his role, he is responsible for supporting VGM and its members, customers, and vendors in understanding market data and trends in the healthcare industry, specifically the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) space. Tyler has previous experience working for nonprofit health systems in roles ranging from human resources, patient access, growth strategy/business development, healthcare operations, project management, and finance. He earned his bachelor’s degree in business administration from the University of South Dakota and a Master of Healthcare Administration from the University of Iowa. You can connect with him on LinkedIn or contact him at Tyler.Coulander@vgm.com.

Tyler Coulander Market Strategy Manager

VGM & Associates

Four Ways DME Providers Are Optimizing for the Future

By Angie McClure, SVP, Corporate Accounts, and Chris Rose, Director of Key Accounts, VGM & Associates

The DME industry has never been short on change, but today’s environment feels especially demanding. Reimbursement pressures, rising costs, shifting patient expectations, and ongoing regulatory complexity are forcing providers to rethink how they operate and where they invest their time and energy.

The providers best positioned for the future aren’t chasing every new trend. Instead, they’re making thoughtful, disciplined decisions that simplify operations, strengthen patient relationships, and create more resilient business models. Here are four ways leading DME providers are optimizing today to stay competitive tomorrow.

1 Operational Simplicity Through Smarter Processes

Leading providers are lowering their costs and creating more consistent operations by simplifying how work actually gets done. Instead of letting each branch or department do things their own way, they’re aligning around shared workflows for order intake, documentation, fulfillment, and resupply.

Automation is a key part of this shift. Providers are pairing technology with selective outsourcing to simplify daily work. Tools like RCM platforms, BOT uploads, digital intake, and AI reduce manual steps and handoffs, while outsourcing high volume functions, especially resupply and replenishment, helps lower costs and improve scalability.

Why It Matters

As reimbursement tightens, margin protection comes from lowering operational costs. Providers that simplify their workflows can scale efficiently without adding headcount or complexity.

2 Treating Resupply as a Growth Engine

High performing DME providers no longer treat resupply as a transactional activity. Instead, they centralize resupply programs and manage them as a strategic business line directly impacting patient experience, adherence, and long‑term revenue.

Resupply is a strategic business line that impacts patient experience, adherence, and long-term revenue.

Patients want an “Amazon” delivery experience, expecting convenience and reliability. Providers are using automation, outsourcing, and patient initiated workflows to scale to improve adherence, retention, and consistency. Resupply performance is being measured at the executive level, with clear visibility of costs including labor, materials, inventory management, and squeeze rates.

Why It Matters

Resupply is one of the few levers providers can pull that simultaneously improves patient outcomes and creates predictable, recurring revenue without relying on new referrals in a competitive market.

3 Diversification for Stability and Control

Providers planning for the future are actively reducing reliance on any single payer, product category, or vendor. Many are expanding into higher margin services such as sleep, resupply programs, education, and digital engagement.

This approach is focused on doing the right things in a strategic way. Diversification gives leadership more control over revenue streams and creates flexibility when market conditions change.

Why It Matters

Diversifying into higher‑margin services creates more predictable revenue, improves margin mix, and gives leadership more control over growth. The focus is on building a more resilient business model that can absorb market change without disrupting performance.

VGM Playbook: Building a Smarter, Stronger Business.

4 Being Proactive, Not Just Reactive

Rather than reacting to each regulatory or market shift, these organizations build 12 to 24‑month roadmaps tied to merger & acquisition (M&A) activity, market expansion, and evolving payer mixes. They engage peer networks and trusted partners to learn what is working elsewhere and invest in leadership development and change management to support new workflows and technologies.

Why It Matters

Providers who plan ahead adapt intentionally. Those who don’t are forced into rushed decisions when external pressures hit.

The Executive Takeaway

The providers winning in today’s environment are simplifying and automating, treating resupply as a growth driver, focusing on the metrics that matter, diversifying intelligently, and planning earlier than their peers. In an industry facing constant change, disciplined execution and thoughtful leadership are proving to be the most durable competitive advantages.

About the Authors

About the Author

Angie McClure is Senior Vice President of Corporate Accounts for VGM & Associates. With an impressive 26 year career in the healthcare industry, Angie has excelled in organizational growth through strategic planning. Her expertise spans the DME and the Senior Living sector and includes leadership roles such as Senior Director of Business Development and Director of Corporate Sales and Marketing for Healthcare of Iowa. Her diverse background equips her with a unique blend of strategic insight and operational know how that directly benefits our corporate accounts. Angie is known for her client‑first approach and building strong, collaborative partnerships that prioritize member success. You can connect with Angie on LinkedIn or at Angie.McClure@vgm.com.

Chris Rose is the Director of Key Member Accounts at VGM, where he is dedicated to serving as a strategic resource for members, helping them grow, adapt, and succeed in an evolving healthcare landscape. With over 23 years of experience in the DME industry, Chris brings deep expertise and a strong understanding of member needs and business challenges.

Prior to his current role, Chris spent 11 years as a Regional Account Manager with Philips Respironics, where he developed strong partnerships and delivered solutions that drove customer success. His career has been defined by a commitment to building relationships, providing value driven guidance, and helping organizations reach their full potential. You can connect with Chris on LinkedIn or at Chris.Rose@vgm.com.

Angie McClure SVP of Corporate Accounts

VGM & Associates

Chris Rose

Director of Key Accounts

VGM & Associates

VGM Playbook: Building a Smarter, Stronger Business.

Rethinking How Work Gets Done

Doug Brandberg, General Manager, Brightree

For years, HME providers managed complexity the same way: by adding effort. More staff. More tools. More process layered on top of what already existed.

In the past, even if not ideal, that approach enabled HMEs to manage through complexity when margins were steadier, labor was easier to find, and operations were more predictable.

Today, that approach breaks down.

Providers are now operating in an environment defined by tighter margins, increasing payer complexity, rising patient expectations, and growing demand for home‑based care. The pressure isn’t isolated to one function; it’s happening across the entire organization all at once.

And adding more effort doesn’t solve it. In many cases, it makes it harder to manage –and can even increase the complexity.

What’s required now isn’t incremental improvement. It’s a structural shift in how work truly gets done. What’s required is a structural shift in how work truly gets done.

Most Operational Problems Don’t Start Where You Think They Do

When performance slips, the instinct is to look at individual functions—intake, billing, documentation—and try to improve each one.

But most HME organizations don’t struggle because those functions are broken. They struggle because of how work moves between them.

Across intake, eligibility, documentation, billing, fulfillment, resupply, and collections, each step may work reasonably well on its own. The breakdown happens in the handoffs.

Information is re entered. Steps are repeated. Teams operate with partial visibility. Small delays at the front of the process surface weeks later as denials, rework, or delayed payment.

We see it consistently:

• Intake slowed by manual data entry

• Documentation gaps that introduce downstream

Rethinking How Work Gets Done

• Disconnected systems forcing workarounds

• Delays that impact both patient experience and cash flow

Individually, these issues seem manageable. Together, they compound.

At a certain point, the constraint is no longer effort—it’s flow.

Improving Steps Isn’t Enough Anymore

For years, optimization meant improving individual parts of the workflow: making intake faster, reducing billing errors, and increasing staff productivity.

Those improvements still matter, but they no longer change the trajectory of the business on their own.

What matters now is how the system performs end to end—across the entire workflow.

What matters now is how the system performs end to end—across the entire workflow.

You can recognize that shift when:

• Systems move work forward instead of simply documenting it

• Tasks are completed with fewer manual touchpoints

• Actions are coordinated across teams, not siloed within them

• Growth no longer depends on adding headcount

This isn’t about layering in more technology. It’s about whether the existing system allows work to move cleanly from one step to the next.

When it does, performance improves across every dimension—from speed to accuracy—while strengthening both cash flow and the patient experience.

The Right Balance: Automation Handles Volume, People Handle Judgment

As organizations rethink their operating model, one principle is becoming clear: not all work should be handled the same way.

High‑volume, rules‑based tasks can, and should, be automated.

Work that requires judgment, context, and human interaction should not.

High-volume, rules-based tasks can, and should, be automated.

Work that requires judgment, context, and human interaction should not.

In a human‑in‑the‑loop model:

• Automation handles throughput

• Systems surface exceptions and risk

• People focus on decisions that require experience

That balance matters more than ever in healthcare, and it’s where many organizations get it wrong. VGM Playbook: Building a Smarter, Stronger Business.

Rethinking How Work Gets Done

Technology can verify eligibility, validate documentation, and identify potential issues. But it cannot build trust with a patient, navigate nuanced clinical situations, or strengthen referral relationships.

The goal isn’t to remove people from the process. It’s to make their time more valuable.

When administrative burden is reduced, teams can spend more time engaging patients, intervening earlier, and focusing on higher‑impact work.

Systems Should Do More Than Store Information

For decades, most HME technology has functioned as a system of record. Systems were built to capture information and support tasks after the fact.

That model is no longer sufficient.

Increasingly, systems are expected to play an active role in execution:

• Guiding workflows in real time

• Reducing manual steps across the lifecycle

• Triggering actions based on data and context

• Coordinating activity across teams

This fundamentally changes how technology should be evaluated.

It’s no longer just about what the system holds. It’s about whether it helps work move forward.

Across the providers we work with, this shift is already underway. It doesn’t happen all at once, but the direction is consistent: systems are becoming participants in operations, not just observers.

Rethinking How Work Gets Done

Resupply Shows What Better Flow Actually Looks Like

Resupply provides a clear, practical example of how this shift plays out.

Traditionally, it’s been treated as a task triggered by fixed schedules or manual outreach. Staff track timing, contact patients, and process orders step by step.

In a more connected model, resupply becomes part of a coordinated lifecycle.

In a more connected model, resupply becomes part of a coordinated lifecycle.

VGM Playbook: Building a Smarter, Stronger Business.

Patient behavior, eligibility, and documentation status inform timing. Outreach is proactive. Orders move forward with fewer manual steps.

The operational impact is measurable: improved adherence, more predictable revenue, and reduced administrative burden.

But the more important change is how teams spend their time.

One provider serving a large pediatric population described how resupply automation reshaped their operations. Routine reorders, patients who simply need their next shipment, are now largely handled by the system.

That shift allows their team to focus on what they described as “hands on touch points.”

Instead of processing orders, staff spend time supporting patients whose needs are changing. That hands‑on approach allows them to adjust products as children grow, and address sensitive needs like discretion in school environments— things a system alone can’t do well.

The work didn’t go away. It became more meaningful.

Automation Should Reduce Work, Not Distance People From It

In HME, automation is often framed as a replacement strategy. In practice, it works best as a support system.

Its role should be straightforward:

• Reduce repetitive work

• Improve consistency

• Accelerate predictable processes

What it should not do is replace clinical judgment, remove accountability, or distance teams from patients. In fact, it should bring teams closer to patients where it matters most.

The most effective organizations use automation to handle work that doesn’t require human decision making—and elevate the work that does.

That distinction is what allows organizations to scale without compromising quality.

Rethinking How Work Gets Done

This Shift Is Already Happening

This isn’t a future state concept; it’s already happening.

Many organizations still operate with:

• Manual intake and verification

• Reactive billing and denial management

• Labor intensive resupply processes

But that model is steadily evolving toward:

• Automated intake and validation

• Cleaner claims with fewer denials

• Proactive, lifecycle‑driven resupply

• Faster, more predictable cash flow

This isn’t a single transformation event. It’s a progression.

The organizations making the most progress aren’t trying to change everything at once. They’re focusing on where friction has the greatest impact and addressing it deliberately.

You Can’t Solve This Alone

No single organization can execute this shift alone.

Progress depends on coordination across:

• Technology partners delivering scalable capabilities

• Service partners supporting execution

• Providers aligning strategy with day to day operations

This isn’t just about adopting new tools. It’s about building the right structure around how work gets done.

Organizations that treat this as a series of disconnected decisions tend to stall—this is where many get stuck. Those who approach it as an operating model shift move faster and see more durable results.

VGM Playbook: Building a Smarter, Stronger Business.

Start With Clarity, Not Transformation

For HME leaders, the starting point isn’t a large scale transformation initiative. It’s a clear understanding of where friction exists today.

The starting point is a clear understanding of where friction exists today.

Start with a few simple, practical questions:

• Where is work slowing down?

• Where are teams compensating for system gaps with manual effort?

• Where does lack of visibility create risk or delay?

• What could be automated without losing control?

The answers don’t need to be perfect. But they need to be honest.

From there, progress becomes focused and measurable.

The Organizations That Win Will Fix the Flow

HME is entering a more demanding phase—but also one with a significant opportunity to connect more closely with patients and deliver better care.

Pressure on operations, margins, and patient experience will continue to build. The organizations that succeed won’t be the ones that simply add more resources.

They’ll be the ones that remove the most friction and do so systematically, deliberately, and at scale.

Because when work flows the way it should, people can focus on what matters most: the patient.

About the Author

Doug Brandberg is Brightree’s General Manager, bringing more than 30 years of leadership experience across software, data, and technology businesses. Doug has held executive roles spanning strategy, operations, finance, M&A, sales, operations, and investor relations across Fortune 500 enterprises and high growth SaaS companies. Throughout his career, he has championed forward‑ looking growth strategies – leading meaningful investments and strategic initiatives that positioned businesses to stay ahead of industry change and deliver sustained performance. Doug joined Brightree in 2019 as Chief Financial Officer, where he strengthened financial performance, advanced the company’s growth strategy, and led and integrated successful acquisitions. His responsibilities later expanded to include broader financial and operational leadership across Resmed’s Residential Care Software portfolio. As General Manager, Doug leads Brightree’s continued growth and innovation – ensuring the company invests strategically in emerging technologies while delivering measurable value to customers and partners across the post‑acute care system. Prior to joining Brightree and Resmed, Doug held senior leadership roles in both Fortune 500 and private equity‑backed technology companies including BellSouth/AT&T, Equifax, First Data Corporation, and GoDaddy. Doug holds a bachelor’s degree from the University of Virginia and an MBA from Georgia Institute of Technology, and is a CFA® charterholder. Connect with Doug on LinkedIn.

Doug Brandberg General Manager Brightree

Optimizing Your Business for the Future: Where Revenue Is Won or Lost

By Amie Barone, Chief Operating Officer, ACU-Serve

There is a growing assumption across healthcare that the future of revenue cycle performance will be driven by more advanced AI.

In reality, the organizations that will outperform over the next five years won’t be the ones with the most advanced tools. They will be the ones who understand where revenue is actually being created and where it is quietly being lost.

Because today, most revenue loss isn’t happening where leadership is looking.

It is not primarily an A/R problem. It is a design problem.

A meaningful percentage of revenue is either delayed or lost due to preventable upstream issues and errors that never fully surface in standard reporting.

In most organizations, a meaningful percentage of revenue is either delayed or lost due to preventable upstream issues and errors that never fully surface in standard reporting. They are written off, adjusted, or quietly absorbed as part of doing business.

That is what makes them so dangerous. They are not visible enough to trigger change, but significant enough to impact financial performance.

And until that shifts, no level of investment will deliver the return organizations expect.

The Real Gap: Where Revenue Breaks Before It’s Measured

Most organizations evaluate performance through what they can see about aging, collections, and denial rates. But those are lagging indicators. They reflect decisions that were made weeks or months earlier.

The real breakdown is happening upstream.

At intake, small inaccuracies compound quickly and often go undetected until it is too late. Insurance verification is frequently treated as a confirmation step rather than a detailed analysis at the HCPCS level. As a result, requirements such as prior authorization, frequency limitations, or product specific coverage nuances are overlooked.

We regularly see authorizations approved under the wrong servicing location, tied to incorrect HCPCS codes, or aligned to inaccurate quantities. On paper, the authorization exists. In practice, it guarantees denial.

Documentation follows the same pattern. Records are collected but not consistently validated against payer‑specific medical necessity criteria. Diagnosis codes may be present but not qualifying. Clinical documentation may exist but does not support reimbursement.

Optimizing Your Business for the Future: Where Revenue Is Won or Lost

These are not isolated issues. They are systemic gaps that create downstream friction and ultimately, lost revenue. Systematic gaps create downstream friction and lost revenue.

Layer in the complexity of payer behavior, frequent policy changes, evolving fee schedules, increasing audit activity, and the margin for error becomes even smaller. Organizations that are not actively adjusting to these shifts are operating on outdated assumptions.

By the time these issues surface in A/R, they are no longer operational problems. They are financial losses.

Why “Good Enough” Performance Is Costing More Than It Appears

One of the biggest risks for leadership teams today is misplaced confidence.

A/R can look stable. Teams can appear productive. Reports can show consistent performance.

But underneath that stability, there are often signs of inefficiency and lost revenue that are easy to overlook.

Adjustments and write offs may be masking preventable issues. Short pays may not be fully pursued. Denials may be resolved without ever being analyzed for root cause, allowing the same patterns to continue.

Even strong aging metrics can hide payer specific delays or product level issues that are never fully addressed.

At the same time, rising labor costs are often accepted as part of doing business. But when teams are spending time correcting errors, chasing documentation, or reworking claims, that is not a staffing issue; it is a process issue.

The organizations that will move ahead are the ones willing to challenge the assumption that “manageable” equals optimized.

The most expensive revenue problems are often the ones that never make it into denial reports. They are adjusted, written off, or simply never pursued because the effort to recover them outweighs the perceived value. Over time, that becomes embedded in the operation and accepted as normal.

The Shift Leaders Need to Make

Optimizing for the future requires a shift in how revenue cycle performance is defined and managed. First, it requires moving accountability upstream. Revenue cycle success is not created in collections; it is protected or lost at intake. That means intake can no longer function as a transactional step. It has to operate as a

Optimizing Your Business for the Future: Where Revenue Is Won or Lost continued...

controlled, informed, and highly accountable function that understands payer requirements, documentation standards, and downstream impact.

When you evaluate the revenue cycle end‑to‑ end, not in silos, but as a connected system, these issues rarely exist in isolation. They are patterns. And until they are addressed at the source, they will continue to repeat, regardless of how much effort is applied downstream.

Second, it requires connecting decisions across the revenue cycle.

What happens at intake must be directly tied to what shows up in A/R. Denials should not be treated as isolated events. They should be traced back to their source and used to drive immediate correction. Without that feedback loop, organizations are solving the same problems repeatedly.

Third, it requires a more disciplined approach to payer management.

Payer behavior is not static, and organizations that treat it that way will continue to absorb unnecessary write‑offs. Understanding payer‑ specific rules, monitoring audit trends, and adjusting workflows accordingly are no longer optional. They are core operational requirements.

The Role of Technology and Its Limits

Technology will continue to play an important role in the future of revenue cycle management. It can improve visibility, increase speed, and support better decision making.

But it does not replace operational discipline.

Technology does not replace operational discipline. VGM Playbook: Building a Smarter, Stronger Business.

Your Business for the Future: Where Revenue Is Won or Lost

Systems can only perform as well as the processes behind them. If workflows are inconsistent, documentation is incomplete, or requirements are not clearly defined, technology will not correct those issues. It will simply move them through the system faster.

This is where many organizations are seeing a gap between expectation and reality.

The opportunity is not in adding more tools. It is in ensuring that the foundation those tools rely on is strong enough to support them.

What Optimization Actually Looks Like

For leadership teams, optimizing for the future is not about doing more. It is about doing the right things with greater precision.

It means ensuring that documentation is not just collected, but validated before services are delivered. It means building payer‑specific workflows that reduce variability and improve consistency. It means creating visibility not just into outcomes, but into the decisions that drive those outcomes.

It also means prioritizing outcomes over activity.

Productivity metrics will always matter, but they are not the primary indicator of performance. Clean claims, denial prevention, cash acceleration, and cost to collect are what ultimately define financial success.

Organizations that align around those outcomes and build their processes accordingly are the ones best positioned to scale.

VGM Playbook:

Building a Smarter, Stronger Business.

Looking Ahead

Leaders will need to make faster decisions with better visibility. They will need to identify breakdowns earlier, understand why they are happening, and correct them at the source—not after they reach A/R.

The question is no longer whether these issues exist. It is whether your organization has the visibility, alignment, and accountability to identify them before they impact cash.

Because in most cases, they are already there.

About the Author

Amie Barone serves as Chief Operating Officer at ACU Serve, where she leads the operational strategy and execution across the organization’s full revenue cycle management platform. Since joining the company in 2006, Amie has played a critical role in scaling ACU Serve into a national partner for HME and infusion providers, ensuring performance, consistency, and accountability at every stage of the revenue cycle.

She oversees all core operational functions, including A/R, quality assurance, documentation retrieval, order intake and processing, and cash posting, as well as ACU‑ Serve’s U.S. and global delivery teams. Under her leadership, these teams are aligned around one goal: driving measurable financial outcomes for clients through disciplined execution, process optimization, and embedded compliance.

In addition to operations, Amie leads client services, working directly with partners to identify opportunities to improve revenue performance, accelerate cash, and reduce operational friction. Her approach is rooted in hands‑on execution, bridging the gap between strategy and day to day performance to ensure clients see real, sustained results.

With nearly two decades of industry experience, Amie brings a deep understanding of the complexities facing today’s providers, particularly in high‑pressure environments like infusion and respiratory care. She is known for her ability to identify where revenue breaks down, implement scalable solutions, and build teams that deliver with precision.

Amie is a graduate of The University of Akron and remains actively engaged in advancing operational excellence throughout the healthcare revenue cycle. Connect with Amie Barone on LinkedIn.

Amie Barone Chief Operating Officer ACU-Serve

Optimizing Your Business for the Future: A Revenue and Financial Performance Imperative

By Jamie Downing, SVP of Business Solutions, VGM & Associates

Let’s face it, the industry is operating in an environment defined by reimbursement pressure, regulatory complexity, workforce constraints, and rising patient expectations. Future‑thinking HME organizations share a common trait: they manage revenue and financial performance with discipline, visibility, and intent. Optimizing an HME business for the future is no longer about chasing volume at all costs; it is about building a resilient financial engine that can scale efficiently, adapt to payer and market change, and consistently deliver both patient value and sustainable margins.

This shift requires HME leaders to rethink how revenue is generated and protected, how financial health is measured across the revenue cycle, and how operational decisions from intake through billing and collections support realistic goals.

Shift from Growth-at-All-Costs to Profitable Growth

Revenue growth remains essential, but sustainable organizations are increasingly selective about how that growth is achieved. The focus is moving toward profitable, repeatable, and defensible revenue streams rather than one‑time wins or low‑margin volume.

The focus is moving toward profitable, repeatable, and defensible revenue streams.

Future‑focused leaders evaluate revenue by margin contribution, identify customers or offerings that challenge profitability, and prioritize recurring or contract‑based revenue models where possible. This opens the door to smarter reinvestment and reduces exposure during market volatility.

Strengthening Financial Visibility and Forecast Accuracy

Financial agility starts with clarity. Organizations optimizing for the future invest in strong financial visibility across revenue, expenses, cash flow, and performance indicators.

High‑performing teams align finance, sales, and operations around a single source of truth and rely on rolling forecasts rather than static annual budgets. Monitoring leading indicators—such as pipeline quality, renewal rates, and customer utilization—allow leadership to act earlier and with greater confidence.

Optimizing Your Business for the Future: A Revenue and Financial Performance

Imperative continued...

Modernize Pricing and Revenue Architecture

Outdated pricing models often fail to reflect evolving customer needs, rising cost structures, or competitive pressures. Organizations positioned for long‑term success routinely revisit how they price, package, and monetize their offerings.

This may include:

• Transitioning from one‑time fees to recurring or usage‑based pricing

• Bundling services to increase perceived value

• Aligning price increases with measurable customer outcomes

When pricing reflects delivered value, revenue becomes more predictable and defensible.

Leverage Technology to Drive Efficiency and Scale

Technology is one of the most powerful levers for improving financial performance, but only when it is aligned with business outcomes. The objective is not tools, but better‑integrated systems that reduce manual effort.

Future‑ready organizations:

• Automate revenue‑impacting processes such as billing, renewals, and collections

• Eliminate data silos between CRM, finance, and operations

• Use analytics to identify inefficiencies and revenue leakage

Efficiency gains directly support margin improvement and scalability.

Efficiency gains directly support margin improvement and scalability.

VGM Playbook: Building a Smarter, Stronger Business.

In the HME industry, reducing revenue leakage is directly connected to revenue cycle optimization.

Complex payer requirements, prior authorizations, extensive documentation, and extended billing timelines create multiple points where earned revenue can be delayed, denied, or written off entirely. Leakage often occurs not because demand is lacking, but because intake, eligibility, clinical documentation, billing, and collections are misaligned or inconsistently executed.

Future‑ready HME organizations treat revenue cycle optimization as a strategic priority: standardizing workflows, tightening documentation and authorization processes, improving front‑end financial clearance, and using data to proactively identify denial trends and aging risks.

By strengthening the entire revenue cycle, HME providers protect margins, improve cash flow, and ensure that operational effort translates into realized revenue.

Invest in Customer Retention and Expansion

Retention and expansion are among the most cost‑effective drivers of sustainable growth.

Forward‑thinking organizations treat customer experience as a financial strategy, not just a service function.

Optimizing Your Business for the Future: A Revenue and Financial Performance

Imperative

continued...

Forward-thinking organizations treat customer experience as a financial strategy.

Align Talent, Accountability, and Financial Outcomes

VGM Playbook: Building a Smarter, Stronger Business.

By proactively manag ing renewals, identifying expansion opportunities, and clearly communicating value, businesses increase lifetime customer value while improving revenue predictability and reducing acquisition costs.

Financial performance depends on deliberate alignment between people, processes, and priorities. Future‑ready organizations clearly define roles, standardize critical workflows, and connect performance metrics directly to revenue, margin, and cash needs. When teams understand how their work influences financial results, and are held accountable to those results, decision‑making accelerates, and organizational silos tend to be reduced.

Conclusion: Building a Financially Resilient Future

Optimizing your business for the future is not a one‑time initiative; it is an ongoing discipline. Leaders who focus on profitable growth, financial visibility, operational efficiency, and customer value create organizations that are resilient.

By intentionally aligning revenue strategy with financial performance, businesses position themselves not just to withstand change, but to lead through it.

About the Author

Jamie Downing is the SVP of Business Solutions for VGM & Associates. Jamie has more than 30 years in strategic healthcare leadership, accelerating top and bottom‑line growth while inspiring relentless execution. Previously, Jamie was the President and part owner of the Sleep Wellness Institute, which was a clinical, diagnostic sleep, and respiratory DME company. Jamie grew the business to 75 employees including six clinics, multiple diagnostics, and nine retail/clinic CPAP locations throughout Southeastern Wisconsin. You can connect with Jamie on LinkedIn or at Jamie.Downing@vgm.com.

Jamie Downing SVP of Business Solutions

& Associates

Digital Transformation Is a Business Decision, Not a Technology Project

By Jason Stortz, Senior Vice President – Production, VGM Forbin

Digital transformation is not a technology project. It is a business decision.

Early in my career, I believed digital transformation was primarily about upgrading systems and adopting new tools. Years of guiding businesses through the process have adjusted that view. The technology matters. But the people, the goals, and the willingness to change matter more. Research from McKinsey confirms this. Organizations that invest in culture change alongside technology see 5.3 times higher success rates than those that treat it as a technology purchase.

Organizations that invest in culture change alongside technology see 5.3 times higher success rates than those that treat it as a technology purchase.

Where to Begin

If you are a business owner considering digital transformation, where do you start? Not with software. You start with questions.

• What is slowing your business down?

• Where are your customers experiencing friction?

• What manual processes consume your team’s time without creating value?

The answers to these questions become the foundation of your transformation. Without them, you are buying tools for problems you have not yet defined.

If you want a structured starting point, open a blank document in Microsoft Word or OneNote and start writing down what you observe. Where are the bottlenecks? What feels manual? What do customers complain about? If you have access to Microsoft 365 Copilot and feel comfortable with it, try giving it a prompt, like, “Interview me about my business operations to help me identify areas for digital improvement.” Let it ask you questions. Your answers become your assessment. You do not need a fancy tool. You need an honest snapshot of where you stand.

Defining Goals

Once you have clarity on the problems, set goals that tie directly to business outcomes. This sounds obvious. It is not always practiced. Whatfix found that 70% of digital transformation initiatives fail to meet expectations, and a primary reason is unclear objectives. Your goals should not be “adopt AI” or “move to the cloud.” Those are means, not ends. Your goals should sound more like “reduce customer response time by 30%” or “automate 50% of invoice approvals.” Measurable. Specific. Connected to how your business makes money or serves people.

70% of digital transformation initiatives fail to meet expectations, and a primary reason is unclear objectives

Digital Transformation Is a Business Decision, Not a Technology Project

continued...

You can track these goals using free Objectives and Key Results (OKR) templates in Microsoft Excel or Google Sheets. Search for “OKR template” in either platform, and you should find ready‑made options. Tability also offers goal tracking for teams, and its website footer includes a list of free tools worth exploring.

A Digital Transformation Framework

I want to share a framework that I found useful for prioritizing these goals. It is called the “Impact and Effort Matrix.” You classify every potential initiative into one of four categories.

1 Quick Wins are high impact and low effort. Implement those first.

2 Big Bets are high impact but high effort. Plan for those strategically.

3 Fill-Ins are low impact and low effort. Handle them when convenient.

4 Time-Wasters are low impact and high effort. Avoid them.

This simple grid helps you focus limited resources where they will create the most value. You can do this on a whiteboard or use a free collaborative tool like Miro, where your team can drag and drop initiatives into the quadrants together.

With your goals defined and prioritized, build a phased roadmap. Do not try to transform everything at once. That is one of the most common mistakes businesses make. Start small. Pick one area of your business, ideally the one that scored highest on impact and lowest on effort, and run a pilot.

Digital Transformation Is a Business Decision, Not a Technology Project

A phased approach might look like this:

• In the first one to three months: Execute two or three quick wins. Automate a manual process. Deploy a Customer Relationship Management (CRM) system. Train your team on a new analytics tool.

• In months four through twelve: Tackle the foundational work. Migrate systems to the cloud. Consolidate your data. Integrate your platforms.

• Beyond twelve months: Pursue the strategic capabilities. Advanced analytics. AI driven automation. New business models. Search for roadmap templates in Excel or Google Sheets to help visualize this process. A simple timeline with phases, owners, and milestones is all you need.

they participate. When they participate, it succeeds. Research from Prosci shows that organizations with strong change management practices are six times more likely to meet their transformation objectives than those without.

Change Management

That brings me to the part most businesses underestimate: change management. I used to think of change management as a soft concept. Something HR handles on the side. I have since learned it is the hardest and most critical part of the process. Your employees will resist change. Not because they are difficult. Because they are human. They have built workflows and habits over the years. Asking them to abandon those without involvement, without training, and without explaining why creates resistance that no technology can overcome.

The solution is communication early and often. Explain why the transformation is happening. Not in a company wide email with vague language about “innovation” and “the future.” Use specific terms. VGM Playbook: Building

This phased approach works for a practical reason: it builds momentum. When your team sees early wins, they believe the transformation is possible. When they believe it is possible,

“We are implementing this system because it will cut four hours per week of manual data entry. Here is how it works. Here is the training schedule.”

Give your people a reason to care. Involve them in the selection process. Let them test the tools before rollout. Celebrate their adoption publicly.

There are pitfalls worth naming directly. Do not lead with technology. Lead with strategy. Do not underestimate the budget. Plan for the hidden costs of training, integration, and the temporary productivity dip that comes with any change. Do not ignore your middle managers. They bridge your strategy and your execution. If they do not buy in, your front line employees will not either. Do not try to transform everything simultaneously. And do not skip the assessment phase. Gartner reports that 87% of organizations in the U.S. consider a digital transformation readiness assessment critical to success. Assess your people, your processes, and your current technology before you spend a dollar on new tools.

One more thing. You will probably need help at some point. Most do. That does not mean hiring a large consulting firm on day one. It means recognizing when you have reached the edge of your internal expertise and finding the right person to help. Sometimes that is a consultant. Sometimes it is a peer who has been through it.

Digital transformation is not about becoming a technology company. It is about using technology to become a better version of the company you already are. The research and the frameworks all point to the same conclusion. Start with clear goals. Phase your approach. Invest in your people as much as your platforms.

Where will you begin?

About the Author

Jason Stortz is a recipient of the VGM Innovator Award and is Senior Vice President of Production at VGM Forbin. He leads delivery including enterprise systems, integrations, and product offerings. A lifelong technologist and entrepreneur, Jason co‑founded Redstone Content Solutions in 2009, growing it into a nationally recognized Oracle Platinum Partner serving commercial and public sector clients worldwide. Redstone was acquired by VGM Group, Inc., and subsequently merged with VGM Forbin, combining deep technical expertise with VGM Forbin’s web offerings, digital marketing, and IT capabilities. You can connect with Jason on LinkedIn or at Jason.Stortz@vgm.com.

SVP of Production

Jason Stortz

VGM Forbin

How AI is Changing SEO Trends in 2026

By Al Strain, SEO/UX Strategist, VGM Forbin

It’s no secret that artificial intelligence (AI) is here to stay. It seemingly started as a buzzword, then became a fun trend, and has now grown into an industry onto itself. AI is evolving so quickly that it is forcing tech giants to change the way you interact with the internet on a daily basis. While Google remains the web’s most widely used search engine, it has recently leaned heavily into AI powered search, creating a more immersive environment that reduces reliance on the organic results familiar over the last thirty years.

AI is evolving so quickly that it is forcing tech giants to change the way you interact with the internet on a daily basis.

So, how does your HME business stay competitive as the AI landscape continues to evolve? VGM

Forbin is here to help you understand what your site needs and offer simple tips to make improvements that AI engines are looking for.

Just How Prevalent is AI?

If you’re not currently using AI, it may still feel like a fad that may pass. However, recent data tells a different story. In a recent survey by McKinsey, 50 percent of consumers reported they deliberately seek out AI powered search

engines. Some other key recent findings include:

50% of consumers reported they deliberately seek out AI-powered search engines 50%

• AI receives 5.4 billion monthly visits in the U.S.

• 78% of business organizations reported using AI in 2024

• 31% of U.S. adults report interacting with AI several times per day

These figures point to one clear point: AI is here to stay. So it’s critical to understand the direction AI is going and how it can help potential customers find your business.

Technical SEO Elements For AI –Schema Markup Helps Your Site Be Found

Whether searchers are using AI apps like ChatGPT or Claude as their primary search engine or utilizing Google’s AI mode that forgoes traditional search results, your site has to be fitted with schema to be discovered. In the simplest terms, schema markup adds labels to content pieces throughout your website to help both traditional search engines and AI engines understand what your content is actually about.

How AI is Changing SEO Trends in 2026 continued...

VGM Playbook: Building a Smarter, Stronger Business.

For example, schema can tell search engines:

• “This is a medical equipment product.”

• “This is a local HME provider location.”

• “This is an insurance or Medicare FAQ.”

• “These are office hours, contact details, or service areas.”

At the end of the day, search engines want to deliver users to the information quickly while ensuring accuracy. HME websites often include critical information related to product eligibility, insurance guidance, service areas, and patient FAQs. Schema helps ensure that information is:

• Understood correctly by search engines

• Matched to the right patient or caregiver search

• Accessible to AI tools that are answering health‑related questions

As AI plays a bigger role in search, schema markup helps ensure your business isn’t overlooked simply because search engines couldn’t clearly understand your site.

FAQs are Key For Product & Service Pages

The onset of AI is changing the way people are searching. Searchers are now using more conversational and long tail keyword phrases when making searches. Users are much less likely to search for something like “powerchair” now. Instead, searchers are using keyword phrases like “What are the key features I should look for in a powerchair?” It’s a search that is still looking for information, but with a much more specific purpose. What does that mean for HME providers looking to capture more web traffic? You need to implement FAQs on key product and service pages throughout

your website. AI engines are built around answering questions and responding in a conversational tone, which invites more questions from the user. It helps users feel more at ease and trust your website. In healthcare‑related searches, accuracy and clarity matter. FAQs help establish trust because they:

• Address common concerns directly

• Use consistent, plain‑language explanations

• Reduce conflicting or unclear information on a page

When paired with FAQ schema markup, this trust is even stronger. The bottom line is FAQs aren’t just for your customers. They’re for AI, too. Implementing FAQs will help search engines and AI tools better understand your services and help your business become more visible when customers are in their decision making window. FAQs aren’t just for your customers. They’re for AI, too.

Keyword-rich Content is Still Critical

At the end of the day, content is still king, whether it helps you be discovered in a traditional search or an AI overview response. The websites that provide the best content with the most clarity for users will be shown higher in organic search rankings and are more likely to be cited in AI overview snippets. But how do you know which keywords are the right ones to focus on?

There are plenty of free keyword research tools out there. One that we recommend is SEMRush. These tools can help you identify what keywords your website is currently ranking for and even assign difficulty scores for how hard it is to rank for individual keywords. Answer Engine Optimization (AEO) focuses on getting your content chosen as the answer to a question. But AI still:

• Uses keywords to match questions with relevant content

• Pulls answers from pages that directly address those terms

• Prioritizes content that is clearly aligned with the user’s intent

If your content doesn’t include the right keywords, it won’t be considered—no matter how helpful it is.

Conclusion

The world of online marketing is continually changing, and AI represents the biggest change the industry has seen in decades. Smart business owners will recognize the importance of these changes and take steps to ensure their website is set up to capture AI traffic as it becomes a bigger part of everyday search behavior. VGM Forbin is here to serve as your partner and keep your site competitive. If you’re interested in learning more about how we can help you navigate the ever‑changing world of AI, please contact us.

About the Author

Al Strain is an SEO/UX Strategist at VGM Forbin. In that role, he is responsible for content creation and UX strategy for all web projects for VGM Forbin’s healthcare clients. Al is passionate about helping businesses streamline their websites to better serve their customers by creating positive digital experiences.

When Al isn’t working with clients to improve their web marketing, he enjoys spending time with his wife and two sons. He’s an avid Minnesota sports fan, accomplished actor, and a below average athlete with the heart of a champion. You can connect with Al on LinkedIn or at Al.Strain@vgm.com.

Al Strain SEO/UX Strategist VGM Forbin

Contract Management Strategies for Sustainable Payer Relations

By Melanie Ewald, VP of Payer Relations and Reimbursement, VGM Group, Inc.

For many DME providers, contracting efforts end as soon as the contract is signed and credentialing is complete. However, to survive, much less thrive, in the current environment, DME providers must embrace contract implementation and ongoing maintenance as an integral part of your payer relations program. How you implement and maintain your contracts is as important as executing them.

It goes without saying that a contract is only as good as the quality of the implementation and ongoing maintenance. That said, you might be surprised how many times a contract is signed, but not implemented, or is implemented, but without all of the terms and communications required to successfully receive payment under the contract.

Full Implementation of Contracts

Understandably, many providers are overloaded with a wide variety of tasks, including the most important task, patient care. However, to be able to continue to provide patient care and run a successful business, providers need to invest in their payer relations program. In particular, one that prioritizes full implementation of an executed contract.

Full implementation includes, but is not limited to:

• Proper setup in the billing software

• Notifications to appropriate teams

• Uploading the contract and related documentation into a contract documentation repository

• Performing regular contract reviews

• Ongoing engagement with the payer

Let’s look at one of the most important, yet often overlooked, aspects of the contracting process: disciplined use of a contract repository and related processes.

Using a Contract Repository

The purpose of a contract repository is to collect the contract and all related documents into a single location as the source of truth. A repository can be a sophisticated enterprise level contract management system or a simple, yet no less effective, internal process utilizing tools such as spreadsheets, shared drives, and, when necessary, hard copy binders.

Contract repositories and the related processes help manage complexity and reduce reliance on employee memory, notes, and discipline. No matter the type of repository you use, the end goal is the same. Repositories help to maximize the return on investment, reduce compliance and audit risks through proper implementation, and support proactive contract management and opportunity growth, resulting in better engagement with payers.

In practice, effective contract implementation and maintenance ensure compliance through daily operations by heading off many issues before they become a problem. Providers often manage several active payer contracts, each with a unique fee schedule, policy manual, prior authorization rules, modifier requirements, documentation standards,

Contract Management

Strategies for Sustainable Payer Relations

continued...

timely filing limits, notification obligations, renewal and termination provisions. Compliance risk arises when contracts, amendments, and provider manuals live in disconnected folders, inboxes, or individual desktops.

An effective contract repository creates a single, reliable source of truth, which helps ensure that your payer relations, billing, and operations teams are all working from the same, current information, thereby reducing risk and supporting payer relations efforts. Even spreadsheet‑based trackers and binders, when maintained consistently with clear naming conventions, clear task owners, and appropriate access, can materially reduce the risk of operating under outdated or incomplete contract terms. Make sure access is easily accessible, but also limited, to appropriate key personnel.

An effective contract repository creates a single, reliable source of truth.

As mentioned, contracts are not static. Fee schedules change, policies are revised, and unilateral amendments are issued. Enterprise systems can automate alerts and version tracking, and a disciplined monitoring process can be equally effective. Calendar reminders, amendment logs, and defined review workflows allow payer relations teams to identify changes, assess operational impact, and communicate updates internally before denials or audit findings occur. In this context, consistency matters more than technology.

Make sure access is easily accessible, but also limited, to appropriate key personnel.

A Proactive Strategy

From an audit and oversight perspective, a well‑maintained contract repository provides defensibility against payer audits, payment integrity initiatives, and government oversight. Maintaining records of contract versions, payer correspondence, implementation dates, and internal compliance actions creates an audit trail that can be invaluable during payer disputes or regulatory reviews. This documentation also helps distinguish isolated errors from systemic non compliance and can meaningfully influence audit outcomes.

Moreover, effective contract maintenance allows you to move from reactive compliance to a proactive strategy. Instead of having to respond to denials and audits after the fact, you can use your contract repository and processes to identify high‑risk provisions and analyze contract viability and opportunities that support informed decisions about network participation and supporting more sustainable payer partnerships.

Contract compliance also applies to payers who are bound by contract terms.

Remember, contract compliance also applies to payers who are bound by contract terms. You can use your contract repository to support your annual (or more frequent) contract and payer performance reviews by streamlining the necessary contract terms and components, allowing you to effectively compare and analyze expected reimbursement to actual payment, patterns of underpayment, delayed payment, and inconsistent policy application. Should an issue be identified, you will be armed with the necessary data and facts to frame the conversation around contractual obligations, increasing the likelihood of a productive payer engagement and resolution.

Lastly, an often underestimated and overlooked risk is the contractual obligations triggered by organizational changes. Changes in ownership, location, licensure, accreditation, scope of services, etc., frequently trigger contractual notification requirements. Missed notification deadlines can lead to retroactive denials, recoupments, or even contract termination. Having a single source of truth that tracks these obligations ensures operational changes do not create downstream financial consequences.

The Key to Elevated Payer Relations: Strategic Use of Contract Repository

In an environment increasingly impacted by aggressive utilization management, narrow or closed payer networks, increased scrutiny, and expanding audit activity, a strategic and disciplined approach to contract implementation and maintenance is no longer optional. DME providers that commit to a disciplined use of a contract repository and related processes are best positioned to withstand the challenges and elevate their payer relations programs from transactional administration to long‑term partnerships.

About the Author

Melanie Ewald’s commitment to the healthcare industry extends beyond her professional roles. She has been actively involved with several DME associations, including serving as a former board member of the Ohio Association of Medical Equipment Services (OAMES) and participating on the American Association for Homecare (AAHomecare) Payer Relations Council.

Melanie is also an attorney specializing in health law with a career deeply rooted in the healthcare industry. Her extensive experience includes roles in a holistic hospital‑based clinic, the Minnesota Hospital Association, and the DME sector. Melanie’s contributions have consistently focused on improving healthcare systems and operations, making her an asset to the VGM Government Relations team and our industry partners.

You can connect with Melanie on LinkedIn or contact her at Melanie.Ewald@vgm.com.

Melanie Ewald VP of Payer Relations and Reimbursement, VGM Group,

Inc.

Beyond the Checkbox: How Education Builds Sustainable Compliance in HME

By Jill Blaser, Senior Director of VGM Education, VGM & Associates

The home medical equipment (HME) industry includes many things: patient care, regulatory oversight, and complexity in operations. Providers must deliver life‑saving equipment and services to patients while still maintaining compliance, which is becoming increasingly complex. Because of this, having well educated employees becomes a priority and forms the foundation for lasting compliance, quality outcomes, and a resilient organization.

Having well-educated employees is a priority for a resilient business.

As regulations grow and change, accreditation standards tighten, and workforce challenges persist, providers must reimagine how education should support compliance. Industry leading companies recognize that compliance is not achieved through check the box education and policies alone, but through well‑developed, organized, ongoing education that equips employees to consistently do their job better.

The Real Compliance Burden on HME Providers

HME providers are monitored by various regulatory agencies and accreditation organizations.

The staff feel the weight of responsibility placed on them by requirements around:

• Medicare

• Accreditation

• HIPAA

• OSHA

• Fraud, waste, and abuse prevention

• Documentation requirements

• Patient care

Non‑compliance can result in serious consequences, including fines, loss of accreditation, or exclusion from federal programs.

Meanwhile, HME employees often come from varied backgrounds, hold specialized roles, and are frequently spread across different locations. Delivery technicians, customer service representatives, billing staff, clinicians, warehouse personnel, and leadership each face different compliance responsibilities. A one size fits all approach to training fails to address the expectations specific to each role.

A one-size-fits-all approach to training fails to address the expectations specific to each role.

Beyond the Checkbox: How Education Builds Sustainable Compliance in HME

continued...

Moving Beyond “Check-the-Box” Training

Education can (and should) act as the tool that turns regulatory language into everyday actions. When employees understand not only what is required, but why it matters and how it applies to their role, compliance can shift from a burdensome obligation to a proactive best practice.

Compliance education in many organizations has historically been driven by minimum requirements, simply checking the box for:

• Accreditation with annual training

• New hire onboarding

• Remediation

This approach may satisfy accreditation requirements, but it does little to reduce risk or improve performance.

Effective compliance education must focus on retention of knowledge, consistent behaviors, and practical applications.

Building Education Into the Culture of Daily Operations

Effective compliance education must be intentional, ongoing, and part of daily operations. It must move beyond the “check the box” mentality and focus on retention of knowledge, consistent behaviors, and practical applications provided on demand as the staff need.

This new view of education and training may require a shift in mindset – both by leadership and employees. The mindset shift to a process that evolves with regulations, technology, and growth will take time and consistent attention. When training is part of daily operations, ingrained into the culture of a business, and specific to each role, employees are better prepared to recognize potential issues earlier, respond appropriately, and help build a culture that values compliance.

How Technology Supports (But Doesn’t Replace) Education

As compliance expectations become more complex, many companies are turning to structured learning management systems (LMS) to streamline education. A centralized LMS allows assignment of:

• Training based on a role

• Simple completion tracking

• Easier record storage

• Better demonstration of compliance during an audit

A strong LMS also supports consistency in training. It ensures that employees across locations receive the same education in onboarding while permitting flexibility to address state specific or role specific requirements. By automating tracking and reporting, organizations can lessen administrative workload while offering leadership clear insight into how prepared the company is for an audit.

An LMS alone will not lead to an effective or transformed education program. The LMS needs to be loaded with relevant and valuable content and a practical strategy for growth. The training materials must align with accreditation standards and meet the needs of the business. Training must meet the needs of all levels of learners in all roles across the company.

Beyond the Checkbox: How Education Builds Sustainable Compliance in HME

continued...

Education as a Risk Reduction and Growth Strategy

A robust education plan will also help reduce risk across many areas of the business. Most compliance issues are not intentional but can be traced back to a misunderstanding of the topic that led to the problem.

Most compliance issues are not intentional but can be traced back to a misunderstanding of the topic that led to the problem.

• The employee didn’t intentionally open the business up to a cyber attack; they didn’t have adequate training to help identify malicious links or attachments in email.

• The employee didn’t intentionally mishandle equipment; they didn’t have the training necessary for proper equipment setup.

• The biller didn’t intentionally submit errors in documentation leading to rejected claims; they didn’t have the comprehensive training needed to keep them current on billing requirements.

When organizations invest in thorough education, employees are better prepared to spot risks earlier. When employees know the correct procedures, documentation requirements, and standards, they are better prepared to do their jobs more confidently and less likely to commit costly errors.

A strong education program also supports consistency during periods of change. Whether onboarding new employees, offering new service lines, or flexing to the increasing number of regulatory changes, consistent training provides stability and clarity. This is especially important in an industry experiencing frequent turnover and increasing demands for operational efficiency.

VGM Playbook: Building a Smarter, Stronger Business.

Compliance is most effective when it is part of the company culture. Education plays a central role in shaping that culture by reinforcing expectations, values, and accountability. Leaders who commit to a culture of education are essential. Employees will notice when leaders prioritize education and model the importance of education and training. It should be talked about as an investment that the company makes into its employees and that employees make to themselves to help them succeed and do their jobs to the best of their ability. Training that is relevant and specific to individual roles increases engagement and improves retention.

The pace of change in the HME industry is going to continue to increase. Companies must continue to keep pace with the changes in regulations, accreditation, technology, and patient demographics. Organizations that view education as a strategic investment in their employees will be best positioned to adapt to the changes in the industry. By aligning education with compliance, operations, and employee development, they can build stronger teams that lead to better business growth.

Education isn’t just training. It’s essential for managing risk, increasing quality of patient care, building trust with employees, and increasing overall growth of a business. For the HME industry, ongoing compliance relies on education from start to finish.

For the HME industry, ongoing compliance relies on education from start to finish.

About the Author

Jill Blaser is the Senior Director of VGM Education, where she oversees the strategic direction, design, and delivery of education and training initiatives serving the HME industry. In this role, Jill focuses on building scalable, customer centric learning solutions that support compliance, professional growth, and business sustainability.

With a collaborative and people‑first leadership approach, Jill works closely with cross functional teams, industry partners, and subject matter experts to ensure education offerings remain relevant, practical, and impactful. She is especially passionate about creating continuous learning pathways that empower individuals and organizations to adapt, grow, and succeed in a changing healthcare environment.

Jill spent 12 years of her time at VGM on the planning committee for the Heartland Conference, serving as both the Education Pillar and Conference Chair, giving her deep insight into the educational, regulatory, and operational challenges HME providers face.

You can connect with her on LinkedIn or at Jill.Blaser@vgm.com.

Jill Blaser Senior Director VGM Education

Auto Fleet Risk Management: A Non-Negotiable for the Future of HME

Connor Bravard, Regional Sales Producer, VGM Insurance Services

As an insurance partner that has spent decades protecting home medical equipment (HME) businesses, we’ve seen how quickly a single auto loss can change the trajectory of an organization. Vehicles are the lifeline of your operation— delivering critical equipment, supporting vulnerable patients, and representing your brand in the community. Yet auto fleet risk is also one of the fastest‑growing threats to your long‑term viability.

If your business is focused on optimizing for the future, auto fleet risk management must be treated as a professional discipline— actively managed, continuously improved, and aligned with today’s realities of insurance markets, litigation, and operational risk.

Auto Risk Is No Longer “Just a Cost of Doing Business”

The HME industry relies heavily on drivers who operate under time pressure, in varied conditions, often while juggling phones, routing apps, and patient needs. At the same time, auto claim severity has increased dramatically. Larger verdicts, higher medical costs, and more aggressive litigation have made even “routine” accidents financially devastating.

Insurance markets are struggling to keep pace. Carriers are absorbing losses that far exceed historical expectations, and many are responding by tightening underwriting standards, reducing capacity, or exiting auto programs altogether. In today’s environment, poor loss history doesn’t just mean higher premiums; it can mean fewer options or no options at all.

Passive Management Is No Longer Enough

Many businesses still manage auto risk passively: renew the policy, replace vehicles as needed, and address accidents only after they occur. That approach is no longer sustainable.

Active fleet risk management means:

• Treating driving as a regulated job function, not a side task

• Setting clear expectations and enforcing standards

• Measuring behavior and intervening early

• Viewing insurance as a financial backstop, not a safety net

Carriers increasingly expect insureds to demonstrate control over their fleets. If you can’t show that control, you may find yourself priced out of coverage—or declined entirely.

Many businesses still

manage auto risk passively. That approach is no longer sustainable.

Auto

Fleet Risk Management: A Non-Negotiable for the Future of HME

continued...

Professional Driver Standards Protect Your Business

Your drivers are your greatest exposure and your greatest opportunity to reduce risk.

Screening matters. Motor vehicle record (MVR) reviews should be conducted at hire and regularly thereafter. Past driving behavior is still one of the strongest indicators of future performance.

Training matters. Defensive driving, distracted driving awareness, and expectations around patient interaction and vehicle use should be formalized, not assumed. Training should be ongoing, documented, and reinforced after incidents.

Accountability matters. Without consequences, policies are just suggestions. Progressive discipline and coaching protect both your employees and your organization.

Telematics and Phone Use: From Optional to Essential

Technology has fundamentally changed fleet risk management. Telematics programs provide visibility into speeding, harsh braking, rapid acceleration, and distracted driving, all behaviors that directly correlate to losses.

Equally critical is limiting mobile phone use. Distracted driving remains a leading cause of serious accidents, and plaintiffs’ attorneys will aggressively pursue cell phone records following a loss. A clear, enforced policy, supported by technology where possible, is no longer optional.

Businesses that resist these tools often cite culture or cost. But the reality is simple: the cost of not using them is far greater.

Some HME operations become effectively uninsurable due to loss history alone.

The Real Consequences of Inaction

We have seen firsthand what happens when auto risk is not taken seriously:

• Premiums increase faster than revenue

• Deductibles climb to unaffordable levels

• Coverage options shrink or disappear

• Contracts are jeopardized due to insurance requirements

• In extreme cases, businesses are forced to park vehicles or close their doors

Some HME operations become effectively uninsurable due to loss history alone. Once that happens, recovery is slow, expensive, and uncertain.

Limits: More Isn’t Always Better

When faced with rising verdicts, it’s tempting to assume that higher limits automatically mean better protection. That’s not always true.

Higher limits come with higher premiums, increased underwriting scrutiny, and often stricter requirements. If underlying controls are weak, more limits simply amplify cost without reducing risk.

The right approach is balance:

• Appropriate limits aligned with your exposure

• Strong primary risk management to prevent losses

• Excess protection that fits your financial reality

Insurance works best when it complements disciplined operations, not when it tries to compensate for their absence.

Optimizing for the Future Starts Now

Auto fleet risk is one of the most controllable (and most consequential) areas of your business. Treating it professionally protects your people, your patients, and your balance sheet.

As insurance markets continue to evolve, the HME businesses that thrive will be those that take an active role in managing risk, embrace accountability, and partner with insurers who understand their world.

The future will favor those who are prepared.

About the Author

Connor Bravard is a proud employee‑owner at VGM Insurance, where he has served as a Regional Sales Producer since 2023. Before joining VGM, he worked as a commercial auto insurance agent, building a strong foundation and deep understanding of the commercial auto insurance landscape, market dynamics, and risk exposures. He proudly serves VGM’s direct clients and retail agents throughout the southeastern portion of the United States.

You can connect with him on LinkedIn or at Connor.Bravard@vgm.com.

Connor Bravard

Regional Sales Producer

VGM Insurance Services

Optimizing Your DME for the Future: Building a Strong, Compliant, and Audit-Ready Organization

By Kelly Grahovac, General Manager, The van Halem Group

The durable medical equipment (DME) industry is evolving rapidly, shaped by heightened regulatory oversight, increased audit activity, payer scrutiny, and ongoing operational pressures. To remain competitive and sustainable, DME suppliers must move beyond reactive compliance and focus on building resilient, well governed organizations. Optimizing your DME for the future requires a proactive strategy centered on internal audits, a strong compliance department, and accurate, up‑to‑date enrollment records.

Proactive Compliance as a Business Strategy

Compliance is no longer a “check‑the‑box” exercise; it is a core operational function that directly affects revenue stability, growth opportunities, and organizational reputation. CMS, Medicare Administrative Contractors (MACs), UPICs, and other oversight agencies continue to increase audit and enforcement activity, making preparedness essential. Organizations that embed compliance into daily operations are better positioned to respond to audits, reduce recoupments, and avoid sanctions such as payment suspensions or revocations.

Future ready DMEs recognize that strong compliance infrastructure supports both short‑ term operational efficiency and long term viability.

Strong compliance infrastructure supports both short-term operational efficiency and long-term viability.

Reducing Fraud, Waste, and Abuse: Why Compliance Pressure Is Intensifying

Reducing fraud, waste, and abuse across Medicare and Medicaid has become a top priority for the current administration. While that goal is broadly supported, the real‑world impact on DME suppliers is significant. As enforcement strategies evolve, many well‑intentioned and highly compliant suppliers are finding themselves swept into expanded oversight efforts that do not always reduce fraud, waste, and abuse, but still carry operational consequences.

CMS continues to identify DMEPOS as a persistent risk area for improper billing and fraud schemes, shifting its focus from a traditional “pay and chase” model toward a more aggressive “detect, stop, and prevent” approach. This shift signals heightened scrutiny earlier in the claims process and increased reliance on data analytics, enrollment controls, and pre‑payment review mechanisms.

Optimizing Your DME for the Future: Building a Strong, Compliant, and Audit-Ready Organization

continued...

Several recent initiatives underscore this heightened focus. CMS has launched a Tax Fraud Partnership encouraging states to collaborate in identifying suppliers engaged in both healthcare and tax fraud, based on the premise that providers committing healthcare fraud may also be underreporting income.

At the same time, CMS continues to frame competitive bidding as a fraud‑reduction tool, asserting that lower fee schedules help remove financial incentives for abusive practices. Additional measures—including stricter accreditation standards, more robust enrollment requirements, and a moratorium on new DME supplier enrollments—further signal that DME providers will remain a priority focus for oversight agencies.

Looking ahead, technology will play an even larger role in enforcement. CMS has announced expanded use of Artificial Intelligence (AI), including the Wasteful and Inappropriate Service Reduction (WISeR) Model, which will leverage AI to conduct prior authorizations for selected at‑risk services. While DMEPOS products are not yet included, the industry widely anticipates they will be added. Notably, AI vendors participating in this model are reimbursed based on cost savings achieved, creating strong incentives to deny claims—raising the stakes for documentation accuracy, coverage compliance, and audit readiness.

Taken together, these developments make one reality clear: maintaining a strong, proactive compliance program has never been more critical for future‑ready DME suppliers. In an environment where enforcement tools are expanding and scrutiny is intensifying, organizations that invest in compliance infrastructure are better positioned to avoid unnecessary scrutiny, penalties, and operational disruptions.

The Critical Role of Internal Audits: Identify Risk Before Escalation

Internal audits are one of the most effective tools for identifying risk before it becomes a liability. Regular, structured internal audits allow DMEs to assess billing accuracy, documentation sufficiency, medical necessity, and adherence to coverage and payer requirements.

Rather than waiting for a post payment audit to uncover deficiencies, internal audits provide actionable insights that allow corrective action in real time. This forward looking approach enhances compliance maturity and builds confidence across leadership, staff, and external partners.

Optimizing Your DME for the Future: Building a Strong, Compliant, and Audit-Ready Organization continued...

Building and Empowering a Strong Compliance Department

A strong compliance department is foundational to future optimization. Whether compliance functions are centralized in a dedicated department or distributed among trained leaders, they must have authority, independence, and direct access to executive leadership.

A strong compliance department is foundational to future optimization.

Key components of an effective compliance program include:

• Written policies and procedures tailored to DME operations

• Ongoing education and training for staff at all levels

• Clear reporting pathways for compliance concerns

• Consistent monitoring, auditing, and corrective action processes

Empowered compliance teams help align operational decisions with regulatory requirements and payer expectations. This alignment reduces risk while fostering a culture of accountability and ethical conduct—an increasingly important differentiator in a highly regulated healthcare environment.

Accurate and Current Enrollment Records: A Non-Negotiable Requirement

Enrollment accuracy is often underestimated, yet it remains one of the most frequent causes of compliance action against DME suppliers. CMS enrollment records must be current, complete, and consistent with actual business operations. Failure to timely report changes can result in revocation, claim denials, or referral to program integrity contractors.

Optimizing Your DME for the Future: Building a Strong, Compliant, and Audit-Ready Organization continued...

Key enrollment elements that require ongoing attention include:

• Ownership and managing control disclosures

• Practice locations and service addresses

• Authorized officials and delegated officials

• Accreditation status and supplier standards compliance

Enrollment maintenance should be treated as a continuous process, not a one time exercise during initial enrollment or revalidation. Regular reviews of PECOS records against real world operations help prevent discrepancies that may trigger audits or enforcement actions.

Integrating Compliance Across Operations

Optimizing your DME for the future means integrating compliance across departments, including intake, billing, delivery, documentation, and leadership. Compliance cannot function in isolation; it must be embedded into workflows, reinforced through training, and monitored through measurable outcomes.

Organizations that succeed in this integration often benefit from:

• Fewer claim denials and audit findings

• Faster response to audit requests

• Improved staff confidence and competency

• Enhanced payer and referral source trust

This holistic approach transforms compliance from a perceived burden into a strategic asset.

Preparing for What Comes

Next

The future of DME will continue to be shaped by regulatory change, data analytics, and increased oversight. As enforcement tools evolve and scrutiny moves earlier in the claims lifecycle, suppliers that invest today in internal audits, strong compliance leadership, and accurate enrollment records will be better prepared to adapt tomorrow.

Optimization is not about avoiding audits; it is about being ready for them before they happen. By strengthening compliance foundations now, DMEs can mitigate risk, protect revenue, support growth, and ensure long‑term success in an increasingly complex healthcare landscape.

About the Author

Kelly Grahovac serves as the General Manager for The van Halem Group, where she focuses on audits, appeals, education, and training across multiple lines of business and various specialties. Kelly is a known lecturer in the DME industry, speaking at national conferences, state associations, and private events. Kelly’s past experience includes nearly 10 years at one of the nation’s leading Medicare contractors, working at the DME MAC, QIC, and A/B MAC contractors. She has since brought this knowledge and experience over to The van Halem Group, where she has been working since 2013 to assist providers as they navigate the ever changing healthcare payor landscape. You can connect with Kelly on LinkedIn or contact her at Kelly@vanHalemGroup.com.

Kelly Grahovac General Manager

The van Halem Group

www.vgm.com