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DME Billing Services
How to order DMEPOS items correctly?
As per the Medicare Program Integrity Manual, Chapter 5 (Items and Services Having Special DME Review Considerations), before you dispense any DMEPOS item to a beneficiary, you need to have an order from the treating physician. Please note that this article is intended for suppliers billing Durable Medical Equipment (DME) MACs for Durable Medical Equipment Prosthetics, Orthotics Supplies (DMEPOS) provided to Medicare beneficiaries. Verbal or preliminary written orders: Suppliers may dispense most items of DMEPOS based…
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DME Billing Services
Physician Liability for DMEPOS Medical Necessity
The Medicare program only pays for health care services that are medically necessary. In determining what services are medically necessary, Medicare primarily relies on the professional judgment of the beneficiary’s treating physician, since he or she knows the patient’s history and makes critical decisions, such as admitting the patient to the hospital; ordering tests, drugs, and treatments; and determining the length of treatment. In other words, the physician has a key role in determining both…
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How to become DME Supplier for Medicare?
The regulation of businesses providing Durable Medical Equipment (DME) or Home Medical Equipment (HME) is dependent upon the types of equipment, as well as the jurisdiction. Since the term DME covers a wide array of devices, from crutches to catheters to wheelchairs to blood glucose monitors, it may not always be clear for businesses whether they must be licensed in a particular state. Furthermore, additional permitting may be required for certain types of equipment (e.g.,…
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Common Modifiers for DME
When billing for durable medical equipment (DME), use the appropriate HCPCS code and modifier(s) to describe the items being billed. Also, include an ICD-9/ICD-10 diagnosis code indicating the medical condition for which the item has been prescribed. In addition to an appropriate HCPCS code for the DME item, many HCPCS codes require a modifier. The modifiers are used to provide more information about the item. For example, the modifier may tell HMSA that an item…
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DME Billing Services
3 Tips to Analyze Payer Reimbursement for DME
Some things in life are very easy and straightforward. Unfortunately, purchasing things such as splints, prosthetics, and durable medical equipment (DME) – and determining which orthotics are covered by insurance – isn’t so cut and dried. In fact, a lot can go wrong when it comes to orthotics and prosthetics billing. So, to make sure your patients get with they need – and you get paid what you deserve – stick to the following guidelines.…
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