DMEPOS Archives - Page 2 of 4 - DME billing and coding blogs

Prior Authorization Process for DME during COVID-19 – Provider Burden Relief FAQs

The importance of medical review activities to CMS’ program integrity efforts, CMS will stop exercising enforcement discretion for the Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items beginning on August 3, 2020, regardless of the status of the public health emergency. Is CMS suspending most Medicare Fee-For-Service (FFS) medical […]

DME Supplies for Children with Disabilities

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 […]

DME Supplies: CMS Flexibilities to Fight COVID-19

From the beginning of the outbreak, the government has issued an uncommon range of temporary regulatory exemption as well as new rules and regulations in order to solidify the American healthcare system with the utmost flexibility to fight with the Novel Coronavirus (COVID-19) pandemic. These temporary changes in the guidelines will apply all over the […]

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 […]

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, […]

Common Modifiers for DME

When billing for durable medical equipment (DME), use the appropriate HCPCS code and Modifiers for DME Services 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. Let’s understand the Durable Medical Equipment Modifiers for DME Services. Common Modifiers for DME In […]

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 […]

Durable Medical Equipment (DME) Billing Blogs