Inbound vs Outbound DME Orders: Which Works?

0:00The question: inbound vs outbound

OK Usman bhai, basically I have some questions I want to ask, and a lot of comments also come in asking what outbound and inbound are, so please explain it a little so the audience also learns the difference between inbound and outbound. The simplest definition of outbound and inbound would be this: outbound means call centers cold-call patients, and at the patient's request, I mean, first they generate leads through cold calling, and then, at the patient's request, they send a prescription to the doctor's office and get the doctor to sign that prescription, and then they bill the patient's insurance, which is a compliance red flag, because when they generate the lead, they tell the patient, you don't even have to pay anything for that, all the cost is covered under your benefits or by the insurance company.

0:26Outbound orders and their compliance risks

So that is basically outbound.

1:01Inbound: doctor referrals and provider relationships

And inbound is provider relationships: you take your product range and your coverage, you show your accreditation, and you also tell them your radius, which radius you serve, because many DME supplies are only profitable if you serve them within a certain radius of your DME, for example a hospital bed: if the insurance changes, how will you go that far to pick up a hospital bed? So, the supplier, the DME owner, can simply pick it up in their own vehicle. So for some products, especially rentals, the savings come from working within a radius.

So yes, you make a good flyer for it and pitch it to the doctor's office. You try to reach the doctor's office's referral coordination department, and you try to reach the social worker.

2:00Home health agencies and nursing homes

Then for Part B billing there is a separate policy. In a nursing home, Part A is active because the patient is admitted. So Part A is active, but when we talk in detail about nursing homes, we will definitely discuss this then. And it can apply in hospice too, if Part A is not active. OK, my next question: people go outbound because the profit comes quickly, while inbound doesn't bring that much profit, so most people choose outbound so they can make money as fast as possible.

2:28Why many still choose outbound

What do you say about that? Look, what they say is: how will we cover our expenses? I mean, when any agency pitches them, saying you will have to invest for a year, around two thousand or two and a half thousand dollars, to build a referral pool of doctor offices, so that forty or fifty doctor offices each send you three orders a week, with multiple supplies in them, they ask how they will cover expenses; I mean, something has to come in so they can pay their bills from it.

That is the mindset of most people. And yes, in outbound the money comes in one go, the money arrives in one shot, and then you have to run the whole year on that same money. But in inbound, if you keep your compliance and all your claims audit-ready, it is a long-term approach. Your first year, year and a half, almost two years can definitely be a bit tough and challenging, but if you specialize in a product and you gather thirty or so doctor offices, your game will change.

3:30Buying data vs building referrals

OK, I want to add one more thing here. In outbound, what we usually saw was this: first, for lead generation, they keep forty or fifty agents, and after that they buy data, and the data, VoIP and voice invoices are all separate. Then they seat ten or fifteen chasers, and then the leads are generated for them, then they ask the doctor's office for approval. It is such a long process. Yes, so many steps get involved, so the more cost it takes, I mean, you have to pay all that cost too.

Now, in inbound, from what I have understood so far, the benefit is that you don't need so many agents and their cost, and you don't need to buy data, which is against the rules, and after that you don't need so many chasers, and then you don't have as much stress. So the benefit of inbound is that you are doing legal work. Whatever patients come, they will send to us; it is work with a future. Now in outbound the question is how long you will keep buying data, how long it will keep working.

Whereas in inbound, once you have onboarded forty, fifty, sixty, seventy doctors and you provide them good service, you are in a good position, because once the pool is built, you get fifty, a hundred, two hundred orders, depending on the case. It is long-term work with no stress over data, agents, chasers and so on.

5:04Audit risk in outbound orders

And on audits, from what I have mostly seen, audits are very frequent in outbound, and people think they happen in inbound too. They do happen in inbound too, but of course you can face them. Of course, you can answer the ADR, the additional documentation request, properly and submit it. What you said at the start, that it brings peace of mind, is absolutely right, but even in inbound, compliance, for instance, let me give you an example: if you don't keep an audit team with you, then down the line that becomes a headache for you too, because with most suppliers, when we audit, we open the files and ask, why did you use the KX modifier?

Why did you use the CG modifier? The KX modifier is an attestation. In the same way there are many coding errors, and Medicare's own CERT study, the 2025 one I believe, put DME's improper billing rate, I think, above 50%: improper billing, documentation errors, coding errors. So across the whole DME niche, not just in Pakistan but of course inside the US too, the medical billing being done has coding issues and improper billing, because of which suppliers and DME providers end up taking losses. The second thing: what you said is absolutely right, that its workflow doesn't have that many departments, but as your referral pool grows, you have to form different departments. At the start, even three marketers doing B2B marketing are plenty, and behind them one person for lead intake is enough.

6:31Team structure: in-house or outsourced billing and coding

And billing and coding, of course, if you don't have them in-house, you will have to outsource. And there should be one doctor-coordination team member who, at the start, also handles patient coordination, handles doctor coordination too, and if they can also do lead intake, they handle lead intake too. And three representatives who do B2B provider relationships. And yes, a good consultant who builds the compliance structure. So, step by step. Yes, with this you save the cost of data, you save the cost of VoIP, you save the cost of all that stress, but there are expenses here too.

The website: one more thing came to my mind. You have to make your website really next level in this work, because out-of-pocket patients also come in. And obviously, in referral marketing you cannot waive the patient's insurance share; that is against the rules too. So you have to charge the patient their share. Of course, if the patient has a secondary insurance, then you don't have to charge the patient; the secondary insurance will pay.

7:40Website, social media and reviews

And in this work the website has to be really next level; that is one thing. And you have to spend on ads; you will have to spend on LinkedIn ads, at least fifteen dollars a day, at the very least. And besides that, if you go for social media marketing, and on Google Ads you will have to spend five hundred dollars a month. In social media marketing you will need to spend about twenty dollars a day. Think of this marketing as running for a full year to a year and a half.

Your GMB and Trustpilot will be in good shape, with around thirty, forty, fifty reviews collected, and then you can win in one product line. See, I have given you the whole formula. OK, there was one more question. Most clients expect in inbound that as quickly as possible, within three months, orders will start coming in. What would you say about that? Look, it is natural growth. Like when we plant even a small sapling, if it is not a hybrid but a natural plant, it takes time to grow.

8:28Give inbound time to grow

Just like a baby first stays in the mother's womb for nine months, then comes out and then slowly grows up. Imagine how strange it would be if a baby just out of the womb started talking and started using a mobile phone, Instagram and Facebook. So any traditional work, any organic work, follows nature, so it grows slowly. So the thing is, it grows gradually. I mean, for four or five months, I tell suppliers not to expect anything. First a digital presence gets built, first a relationship gets built, then contracts get onboarded, and your credentialing will be happening alongside.

So yes, it is a whole process of at least a year to a year and a half. It also matters how many products you are accredited for and how many insurers you are contracted with. That is very important: the more insurers you are contracted with and the more products you are accredited for, the better your volume will be.

9:33Payer contracts bring more referrals

If out of these, well, Aetna is not that big an insurer, but with the bigger pools, if you have a contract with one of those two payers, and you are also billing their good plans, your referral ratio will be higher. So contracts are of course a win for you. And along with that, there is something going on these days where people go out of network, without a contract, and bill Medicare Advantage plans as well. They can do that if you have the payer's permission, if you informed the payer and the payer actually gave you permission.

But if you don't have that, then your fifty percent of the market is simply lost, because fifty percent is the original market, which, using the wrong terminology, people in the market also call Part B, but it is the original market.

10:31Original Medicare and accreditation scope

And mostly, I have seen, these outbound DMEs don't have that market. So Medicaid's biggest supply category, incontinence, they can't do, and there is a good margin in it; they are recurring supplies too. So yes, insurance is a very big win. And along with that, accreditation, which we talked about, is the most important thing: whatever products you are accredited for are the only ones you can do, and the ones you aren't accredited for, you can't. And at accreditation time, it is better to add your products right from the start, because later they ask for an extra charge and an extra survey.

Think of it as an add-on from the survey company, so it costs extra money. Second, under Medicare's guideline, every DME now has to get accredited every year, and a secret survey, a surprise visit from Medicare, has also been added, which wasn't there before. Before, a three-year accreditation was accepted; now accreditation is for one year. So yes, you need accreditation, at least for the major products. Mobility items get the most audits; they are also called legendary products. And under the new 2028 rules, competitive bidding is coming to more products, even to CGMs.

11:44Upcoming 2028 changes

Like it was on braces before, suppliers who are not bid winners will not be able to do CGMs. And I think it is now coming to incontinence too, and also to absorbent supplies, and besides that to catheters, urological supplies and ostomy too. And yes, wheelchairs and rollators are outside it. But of course, this is only Medicare FFS; it is not about the Medicare Advantage market, which is fifty percent, or the out-of-pocket market, which is twenty percent. That's all my questions. Is there anything you would like to add?

To add, I think we have covered everything. And InshaAllah, if comments come in on our video or people ask us to do a detailed session on this too, InshaAllah we will definitely make it.

12:32Wrap-up and upcoming courses

And our course, which isn't finished yet, the one we were running on YouTube, is stuck in the middle right now because we have been busy, but no matter what, next week InshaAllah we will finish it. And after that, there is a home health agency course too, because people don't even know that DME falls under home health, and home health includes home health agencies and DMEPOS: prosthetics, orthotics and supplies. So the home health agency course is a very big one, because the home health agency market is even bigger than DME.

So that is a detailed course, I think it will run to twenty or twenty-four videos, a long, detailed course. InshaAllah we will do it and build the full package as soon as possible. Now, because people keep joining us, the appreciation is bringing new life into it, and we are enjoying the work. But obviously alongside there is our clients' work, our running workflows, which we must not disrupt. So InshaAllah we will keep this series going like this. And we pray that Allah puts His mercy and blessings in it for us and makes it easy for us. So InshaAllah we will continue. OK, InshaAllah, see you then. JazakAllah khair. Assalamu alaikum wa rahmatullah.