Operating system · Healthcare & Medical

Turn Medicare's prior-authorization crackdown into a recurring-revenue service — the plan, the playbooks, and the numbers already worked out.

The complete operating system for a specialized DMEPOS prior-authorization, appeals, and exemption-cycle service — the narrow back-office firm that wins affirmations for durable-medical-equipment suppliers instead of a full-scope billing shop. Most people who try this compete on breadth and lose to depth: they treat a non-affirmation as a verdict instead of a fixable defect, they miss an appeal clock, and they never build the one service the market is now desperate for — exemption-cycle management under CMS's brand-new rule.

What's inside

The regulatory spine, current and specific — not generic filler. The plan is built on the rules that actually drive this niche's demand: the CMS-1828-F prior-authorization exemption at a 90% provisional-affirmation rate (finalized late 2025; first cycle June 1, 2026 — the greenfield line no competitor has productized), the 7-calendar-day standard PA review clock (effective Jan 1, 2025), the Jan 13, 2026 Federal Register list expansion that took the Required Prior Authorization List to 74 codes, the four DME MAC jurisdictions (Noridian A/D, CGS B/C), and the Medicare appeals ladder (redetermination 120 days, reconsideration 180 days, ALJ 60 days).

An editable financial model built for a labor-COGS service, not a product business. Real, changeable assumptions — the $2,500 monthly retainer anchor, per-appeal overflow (redetermination ~$185, reconsideration ~$325, PA packets ~$45), the $750/mo exemption-cycle subscription, a ~58% gross margin (your cost of goods is trained specialist labor), and a ~$16,400 break-even at roughly six mature clients. Change an assumption; the 36-month build re-flows.

Playbooks written in the niche's own language. The CMS documentation checklist that wins a packet on the first pass (face-to-face note, SWO/WOPD with no signature-timing defect, HCPCS-to-LCD/NCD alignment), the five-bucket denial root-cause taxonomy that lowers future denials, appeal-letter craft that maps each coverage criterion to its supporting document, a system-enforced deadline-integrity layer, and the HIPAA Business-Associate compliance spine (BAA, security risk analysis, CMS-1696 appointment of representative).

Who it's for

Built for the medical-billing or DMEPOS-compliance specialist going independent — someone who already understands Medicare documentation and wants to own the affirmation-rate niche the generalist billers under-serve. Delivered instantly at checkout; single-buyer license. Editions differ by how many playbooks are included — compare the tiers below.

Choose your edition

Edition	What's included	Price
Starter	Business plan + financial model + essential playbooks	$149	Buy Starter
StandardMost popular	Plan + model + all 12 core operations playbooks	$299	Buy Standard
Premium	Plan + model + all 17 playbooks (core + growth & scale)	$499	Buy Premium

Please read before purchasing. This product is an informational and educational operating system — a research-grounded business plan, operations playbooks, and an editable financial model. It is not legal, tax, accounting, financial, or investment advice, and using it does not create a professional-client relationship. Bytell Press does not guarantee any specific business, funding, or financial outcome. You are responsible for your own decisions and for consulting a qualified professional licensed in your jurisdiction before acting.