DME billing

A recent 2016 report by Grand View Research predicted that the durable medical equipment (DME) market is expected to reach USD 242.1 billion by 2024. This will probably turn out right, going by the simple logic that the aging population need for chronic disease management tools and devices and remote monitoring devices will increase in the coming years.  So the physicians and healthcare providers, who are still deciding whether or not to take up DME services as an ancillary service to their practice, will see a greater inflow of revenue keeping the Revenue Cycle Management (RCM) profitable, given the growing need of the geriatric population for use of durable medical equipment.

Although Obama care may and could be rescinded in the coming months, yet certain basic concepts like reducing the length of hospital stay, a key strategy to help reduce medical expenses by the state, will lead to an increase in home healthcare settings. Reduction in length of stay at hospitals will inevitably increase focus towards home healthcare. Hence, for long term care and post-operative recovery, home healthcare will be the preference and will boost the demand in home healthcare. Already with the aid of government funding and public private partnership the numbers of healthcare settings have shown an increase in the last few months.

Long term care and hospitalization for treatment of chronic conditions, such as heart disorders, cancer, gynecological disorders, and neurological disorder is further anticipated to facilitate the demand for durable medical equipment.

Further, the Senate Finance Committee Chronic Care Working Group recently  released a draft healthcare payment reform bill targeting chronic disease management programs and services, such as the Independence at Home Model, Telehealth consultations, accountable care organization (ACO) initiatives, and Medicare Advantage plans. CMS is also testing a payment incentive and care delivery model that establishes home-based primary care teams for Medicare beneficiaries with multiple chronic conditions. All this will give a boost to those engaged in DME services. The working group also proposed to include freestanding dialysis facilities and patient homes in addition to physician offices and hospital-based dialysis centers as authorized originating telehealth sites in 2018.

 

The opportunities for the market players are thus seen as plentiful, facilitating a demand for DME driven by the growing need for DME service in home healthcare.
However, a slight twist to this rosy scenario. CMS recently released a final rule that will reduce Medicare reimbursement to home health providers by $130 million, or 0.7 percent, in 2017. Lower Medicare spending on home health services will stem from updates to payment rates, the Home Health Quality Reporting Program, and the Home Health Value-Based Purchasing Model. But if claims are processed with due diligence and keeping in mind the “medical necessity” rider, then those in DME practice will still see it beneficial to their revenues, rather than a backward step.

This overall, the future for 2017 definitely seems brighter for all healthcare providers who wish to engage in DME services, as the market and economics of it will certainly drive change and growth of demand for DME practice despite the choppy political reforms that is forecasted

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