The term 'Durable Medical Equipment' is usually intended for a continued period of time and includes equipment such as walkers, crutches, wheel chairs, bath chairs, prostheses, oxygen supplies etc. Some of these are dispensed by the practitioner directly from the hospital or are prescribed for buying from other DME suppliers. In order to dispense supplies and equipment, a Durable Medical Equipment Regional Carrier (DMERC) license is required for Medicare patients (provided for covered items).
The Medicare insurance program consists of three parts:
4 Payer Issues for ASCs in 2016 are:
In the DMERC system, the term 'suppliers' constitutes physicians, chiropractors and other practitioners. Here, the practitioner could be the provider, requesting the item; or the supplier, dispensing the item (under certain conditions). The practitioner could be a participating or a non-participating supplier (designation irrespective of the Medicare Part B status), implying that the practitioner could be a participating supplier in Medicare Part B and a non-participating provider for DMERC or vice-versa. The participating supplier shall accept all assignments while a non-participating one can do it on a case-by-case basis.
Medicare Part B participating supplier: Medicare pays 80% of the allowable fee (post deductibles); the rest 20% and deductibles may be collected when the DME item/supply has been dispensed.
DMERC Non-participating supplier: One can collect the entire amount after dispensing the item/supply. The payment check (Medicare) is then sent to the patient.
DME supplier: In the case of purchased DME, for maintenance, replacement or repairs of supplies separate reimbursement is available under an agreed upon maintenance fee with a DME supplier (under certain conditions). In the case of non-covered items, the supplier is responsible for 'acquiring a signed, dated, written contract from the member for the additional charges prior to delivery' (bcbsnc.com). Dentists can become DME suppliers to gain eligibility for Medicare reimbursements for OAT (Oral Appliance Therapy) only and must hold a DME supplier license.
DME provider: DME should always be recommended by a licensed provider and the purchased DME is covered according to maintenance terms of the provider's contracted agreement. For rental, it is as per the provider's contracted rental rates. The equipment is always owned by the DME provider and taken back when no longer needed. Rental fee may not be charged, but a maintenance fee might be. DME is reviewed for necessity by the DME provider as per the treatment intended, time frame and the provider's association in the supervision of DME. Rental and maintenance rates are calculated on a prorated basis by the provider's contracted rates.
All DMEPOS suppliers should comply with HIPAA, ensure appropriate delivery and installation of equipment and ensure a safe environment. They should train the patient and other caregivers on the usage of the equipment, its maintenance and the patients' rights and responsibilities. The DMEPOS providers are expected to obtain third-party accreditation by Centers for Medicare and Medicaid Services (CMS) for long-lasting eligibility under Medicare Part B, thereby enhancing the value of assistance to patients.