DMEPOS

  • DME Billing Services
    New CMS Proposals Streamline Medicare Coverage for Innovative and New Diabetes Devices

    New CMS Proposals Streamline Medicare Coverage for Innovative and New Diabetes Devices

    Lately, CMS has proposed new changes to Medicare Durable Medical Equipment, Prosthetics, Orthotic Devices and Supplies (DMEPOS) coverage, and payment policies. These proposed new changes will streamline Medicare coverage for innovative and new diabetes devices and this brief will help you to understand “How”. The proposed rule for innovative and new diabetes devices New CMS proposals help innovators to understand a more predictable path about the kinds of products that Medicare will pay for. For example – As per the agency, new changes that could expand Medicare coverage for continuous glucose monitors and insulin pumps. However, the current CMS rule only covers therapeutic CGMs or FDA approved for use in making diabetes treatment decisions, such as based on only CGM readings one’s diet or insulin dosage can be changed. New CMS Proposals have expanded the interpretation regarding the appropriate use of external infusion pumps for use in the home and can be covered as DME under Medicare Part B. You will also find the main driver behind the proposed rule is to increase access to drug infusion therapy services in the home including insulin pumps as well as reduce administrative burdens. These administrative burdens mainly occur due to complicated government…

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  • DME Billing Services
    Basics to Open DME Business

    Basics to Open DME Business

    A DME (Durable Medical Equipment) business is a company that deals in healthcare-related items intended for use in the home for an extended period. There are multiple products in DME e.g., wheelchairs, glucose monitors hospital beds, and nebulizers, etc. These products are often covered by insurance plans and Medicare that the equipments are planned for long-term use. Starting a DME business allows you to sell and distribute durable products to those who require them, you will receive payment against these products either directly or through an insurance company that covers DME products. Planning A perfect plan is required for success as an entrepreneur. This will help you to organize and specifies of your business and find some unknowns. Here are some topics to look at: COST: What can be the start-up and ongoing costs? Target: Identify the target market? Pricing: What will you charge the customers? Brand Name: What will be the name of your business? Cost to open a DME / Home health medical supply If you are planning a storefront, finding a good location should be one of the top priority. An average retail showroom can be approximately 1500 square feet, with additional space for storage. According some…

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  • DME Billing Services
    DME Repairs and maintenance

    DME Repairs and Maintenance

    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. Renting DME 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 required for 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.…

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  • DME Billing Services
    Know your DME HCPCS Codes

    Know your DME HCPCS Codes

    In DME medical billing, your DME coders require correct HCPCS codes along with correct modifiers that are used for providing more details about the equipment. If your medical coders are unable to use modifiers or not using them in the correct manner, then the claims may get denied from the insurance company. Some common DME modifiers which include RR- rental, UE- purchase of used equipment, and NU- purchase of new equipment. When a laboratory demand, request for DME is being filled, medical coders will be needed ICD-10 codes for a patient’s diagnosis. To use an appropriate HCPCS code for the DME item, many HCPCS codes need a modifier. Modifiers are used to provide more details about the DME item. e.g. The modifier might indicate HMSA that an item is new, rented on a capped basis, or rented. For capped rentals, modifiers differentiate which month’s rental is being billed. If your billers use these modifiers incorrectly then the claim will be rejected. To speed up this process of your claims, show the first-month rental by adding the appropriate modifier code and bill your claims in successive order. HCPCS Code Range: E0100-E8002: Durable Medical Equipment E0100-E0159: Walking Aids and Attachments E0160-E0162: Sitz Bath/Equipment…

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  • DME Billing Services
    CMS announcement for durable medical equipment suppliers

    CMS announcement for durable medical equipment suppliers

    The Centers for Medicare & Medicaid Services (CMS) announced updated guidance regarding several emergency waivers related to Medicare and Medicaid policies and regulatory updates during this pandemic for durable medical equipment suppliers. The CMS very likely will continue to announce supplemental guidance on the blanket waivers. Here we have a detailed summary of the relevant waivers that will affect durable medical equipment suppliers, prosthetics, orthotics, and supplies (DME) and are projected to prepare the American healthcare system with maximum flexibility to respond to the public health emergency.  These temporary changes will remain in effect across the U.S. healthcare system for the duration of the pandemic emergency declaration. By enacting these waivers, CMS hopes to “put patients over paperwork” to give some relief from vast documentation work, reporting, and audit requirements. Now providers and regulators can focus on providing required care to Medicare and Medicaid beneficiaries impacted by coronavirus. Prior Authorization CMS waiving certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements to release the administrative load of compliances during public health emergencies. In normal conditions, DME suppliers are required to undergo a prior authorization process to make sure that applicable coverage, payment, and medical coding rules are met before…

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  • DME Billing Services
    DME Prior Authorization Programs - GAO

    DME Prior Authorization Programs – GAO

    According to the analysis of GAO, CMS’s prior authorization programs for durable medical equipment (DME) created an estimated $1.9 billion in Medicare savings. CMS’s prior authorization programs for durable medical equipment (DME) and mobility devices have controlled unnecessary spending, according to a new Government Accountability Office (GAO) report. This was created between $1.1 and $1.9 billion in Medicare savings from 2012 to 2017. Prior authorization is a payment approach used by private insurers that generally requires health care providers and suppliers to first demonstrate compliance with coverage and payment rules before certain items or services are provided to patients, rather than after the items or services have been provided. This approach may be used to reduce expenditures, unnecessary utilization, and improper payments. The Centers for Medicare & Medicaid Services (CMS) has begun using prior authorization in Medicare through a series of fixed-length demonstrations designed to measure their effectiveness and one permanent program. According to GAO’s analyses, expenditures decreased for items and services subject to a demonstration. GAO’s analyses of actual expenditures and estimated expenditures in the absence of the demonstrations found that estimated savings from all demonstrations through March 2017 could be as high as about $1.1 to $1.9 billion.…

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  • DME Billing Services
    CY 2020 Update for Durable Medical Equipment

    CY 2020 Update for Durable Medical Equipment

    CMS has revised previous updates of the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule on January 3, 2020, to reflect an updated Change request (CR) that corrected the CY 2020 maintenance and servicing fee for certain oxygen equipment to $73.02 in the CR’ s business requirement 11570.9. The transmittal number, CR release date, and link to the transmittal also changed. All other information remains the same. These changes are intended for providers and suppliers submitting claims to Medicare Administrative Contractors (MACs) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items or services paid under the DMEPOS fee schedule provided to Medicare beneficiaries. The Centers for Medicare & Medicaid Services (CMS) updates the DMEPOS fee schedule on an annual basis in accordance with statute and regulations. For CY 2020, the following applicable Fee Schedule Adjustment Methodologies and fee schedule amounts reflect the area in which the items and services are furnished. Fee Schedule Amounts for Areas within the Contiguous United States Claims with DOS Jan 1, 2019 – Dec 31, 2020 The adjusted fee schedule amounts for items furnished in non-competitively bid rural areas are a blend of 50 percent of the adjusted fee schedule amount and…

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