Durable Medical Equipment at some point needs DME Repairs and Maintenance from your DME supplier.
Repair: DME repairs by a DME supplier include fixing equipment that is damaged or worn.
Maintenance: This simply means cleaning, checking, and servicing the patient’s DME.
If possible, patients are expected to do regular maintenance themselves using the owner’s manual. But DME suppliers are expected to perform maintenance if the task is more complicated and requires a professional.
Providers need to know that Medicare’s coverage of more specialized DME maintenance and repairs totally depends on the whether patient or the supplier owns the equipment.
As long as patients are paying a monthly rental fee for their equipment. DME suppliers must perform all required DME Repairs and Maintenance when a professional is required. The patients do not need to pay a DME supplier for this work.
Patient Purchased/Owned DME
If the patient has purchased their equipment or owns it, Medicare covers required repairs and maintenance whenever a professional is required it. The services are not covered by a warranty.
Whenever patients require equipment and they use the facility of a DME supplier that takes Medicare assignment, Medicare covers 80 percent of the Medicare-approved amount. In this care, patients need to pay 20 percent as coinsurance.
Rules for Oxygen Equipment Rental, Repairs, and Maintenance
Medicare’s coverage rules for oxygen equipment rental, repair, and maintenance are not the same as their normal rules for other DME. Providers need to ensure that patients are using the right kind of supplier to limit their expenditure.
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Oxygen Equipment Rental
The patients never have the option to buy Oxygen equipment, as they rented in a 5-year cycle.
Medicare reimbursement for Oxygen equipment:
Medicare will pay the supplier a monthly rental fee for the first 3-years. This fee will include all equipment, supplies, oxygen, and maintenance. Patients need to pay 20 percent of each month’s rental charges.
After 3 years patient needs not to pay any rental charges to the supplier, though the supplier still owns the equipment. The patient can keep the equipment for additional up to 2 years. In this extended period if the patient is using an oxygen tank or cylinders then the patient requires to pay 20 percent coinsurance.
After a 5-year period, patients will have the choice to get new oxygen equipment from their supplier or to switch to a DME supplier. If the patient is using oxygen equipment for less than 5 years then the patient needs to return the equipment to the DME supplier.
DME Repair and Maintenance of Oxygen Equipment
Throughout the patient’s 5-year rental period, the supplier must keep oxygen equipment up and running conditions.
During the first 3 years of the rental period, the supplier must provide supplies and maintenance free of charge to the patient.
In the last 2 years of the rental period, providers are allowed to bill patients for in-home maintenance visits every 6 months, and their patients have to pay 20 percent coinsurance. Click to know more about the rules for repairs and maintenance of oxygen equipment.
If your patient has a Medicare Advantage Plan, make sure to follow the plan’s coverage rules.
Want to know more about how Medicare covers DME Repairs and Maintenance? or to know DME suppliers in your area? Reach out to our DME billing and coding experts.