There might be a need for medical equipment or supplies for children with disabilities or having special health care needs. Once you identify your child’s needs then, you will be thinking about the different options as well as the ways to pay for durable medical equipment. However, insurance is one of the solutions for your problem as both Medicaid and other health insurance which is often cover some or all of the costs for these medically necessary items.
Following tips are important to walk through for insurance system including Medicaid:
Durable Medical Equipment (DME) and Supplies for Children
DME is a kind of medical equipment, which is generally used for a longer period of time. Majority of the durable medical equipment anticipated to last for more than three years.
Some of the DME’s are as follows:
- Hospital beds
- Hearing aids
- An augmentative communication device especially for children who are unable to speak or possessing some sort of speaking disability
- Manual and power wheelchairs
- Oxygen equipment
Many children who utilize DME also need medical supplies. These supplies are utilized for a short period (sometimes utilized only once) and then disposed of.
Many of these supplies needed on daily as well as a weekly basis, which contain:
- Feeding tubes or syringes
- Diapers and diaper wipes especially for a child having age equal or more than 5 years
- Specialized formulas or food
Tips for obtaining equipment and supplies
- Ask the doctor for your child’s prescription, which clearly explains what type of equipment or supplies needed for your child. In addition to this, specialists or therapists too can help you and suggest proper solutions including suggestions for proper communication devices or measurements for a wheelchair. Once you submit your child’s therapist report to the doctor, it will be convenient for the doctor to write a prescription.
- DME providers are the one who sells medical supplies and equipment. Moreover, they will manage your insurance claims and communicate with your Medicaid or insurance case manager to identify an in-network DME provider. Apart from this, communicating with other parents or receiving recommendations from your therapist or doctor are also effective ways to find DME providers.
- Speak with the DME provider regarding the requirements of your child. They will require understanding about your insurance plan, particular necessities of your child, and how the equipment will be utilized. These things enable DME providers to suggest the best equipment for your child. Additionally, they will guide you regarding prior authorization.
- Finally, the DME provider will receive the prior authorization and file any paperwork with the insurance company. Once they got approval from the payer, the equipment or supplies will be ordered and delivered to the office of your therapist or your home.
Responsibilities of DME provider
DME provider is responsible for offering a correct piece of equipment as well as supplies to fulfill your child’s requirement. DME providers will communicate with payers on behalf of your child, and hopefully, be the advocate of your child in receiving the correct equipment.
The following are the responsibilities for DME provider:
- Communicating with parents once in a month
- Explaining the pros and cons of different type of supplies and equipment
- Delivering as well as the setting up of equipment at the place and giving a demonstration of a delivered equipment
- Managing repairing issues
- Ask for a signature indicating that you received the equipment and were trained on its usage
Responsibilities of parents while accepting any delivery of supplies or equipment
Before you close any delivery of supplies or equipment, ensure that:
- It fits your child
- Proper functioning of a particular equipment
- Crosschecking whether all the listed items are delivered or not
- Checking features of equipment (whether it fits in your home or not)
- Make sure you received the proper training to operate equipment
If you are not satisfied with your DME provider, you can switch for others. You have the freedom to choose any DME provider within your health insurance network. Keep in mind the process of switching might take some extra time. It is your duty to check whether the new provider possesses equipment as per your child’s needs.
Outsourcing your billing and coding loads could help you to accelerate your revenue performance. We have the expertise to handle your DME medical billing and coding. In addition to this, we have a dedicated team of billers and coders with knowledge of upgraded CPT and ICD-10 codes. Collaborating with correct billing and coding service provider will enhance your revenue cycle. Feel free to contact us, until we explore our billing and coding capabilities, which could highly beneficial for you to get timely reimbursed.
FAQs
Q1: What is Durable Medical Equipment (DME)?
Durable Medical Equipment (DME) refers to medical devices that are designed for long-term use, typically lasting more than three years. Examples include hospital beds, wheelchairs, and hearing aids.
Q2: What types of supplies do children with disabilities typically need?
Children may require medical supplies like feeding tubes, diapers, specialized formulas, and other items that are often used temporarily or daily.
Q3: How can I get my child’s DME covered by insurance?
You can have your child’s doctor write a prescription for the necessary equipment or supplies, which will help with insurance claims. Medicaid and other insurance plans often cover some or all of the costs for DME.
Q4: What steps should I take to obtain DME for my child?
Start by obtaining a prescription from your child’s doctor, discussing needs with specialists or therapists, and communicating with DME providers about your insurance plan and your child’s specific requirements.
Q5: What are the responsibilities of a DME provider?
DME providers are responsible for delivering the correct equipment, managing communication with insurance companies, providing training on usage, and addressing any repair issues that arise.
Q6: What should I check when receiving DME supplies or equipment?
Before accepting delivery, ensure that the equipment fits your child, is functioning properly, all listed items are delivered, and that you receive proper training on how to use the equipment.
Q7: Can I change my DME provider if I am not satisfied?
Yes, you have the freedom to switch to another DME provider within your insurance network. Just be aware that the process may take some time.
Q8: How can outsourcing billing and coding help my practice?
Outsourcing DME medical billing and coding can enhance revenue performance by ensuring accurate claims processing and timely reimbursements, allowing your practice to focus on patient care.
Q9: How can I contact a billing and coding service provider?
You can reach out to specialized billing and coding service providers to discuss your needs and explore their capabilities for timely reimbursement.
