Durable Medical Equipment can be positive or negative for a medical practice.  If the process is closely managed, DME can be a profitable part but the rules and guidelines have to be followed. Durable Medical Equipment has to be purchased first and then dispensed to patients according to medical necessity. It becomes critical that practices are reporting the appropriate codes for the items dispensed so that it is advantageous for the practice to dispense these items.  

There are the documentation guidelines created by CMS that identify what must be in the medical record for proving the medical necessity of the item, and the patient’s receipt of the item.  Recently, the standard documentation guidelines for DME changed, so practices need to make sure they are adhering to the changes.  Also, Medicare, as well as commercial insurance companies, have begun to audit the medical records of practices to confirm the patient’s needs for DME. If the appropriate documentation is not there, the practice could be subject to fines and penalties according to their contract with the particular insurance company.  Knowing the rules and guidelines and building a strong program for DME allows practices to be compliant and gain profits.
 

Key Points:-

• Durable Medical Equipment- how to choose a code in HCPCS
• Using Medicare’s Price Data Analysis and Coding File
• Assigning a fee for a DME item
• What information is in the Medicare Jurisdiction list
• CMS requirements for documentation 
• Proof of Delivery
• Advanced Beneficiary Notices
• Local Coverage Determinations (LCD) for DME
• Reasonable Use Lifetime
• Managing inventory

Who Will Benefit?

• Physicians
• Nurses
• PA
• Coder
• Biller
• Manager
• Administrator
• Physician
• Supervisor
• Claims Adjuster
• Collector
• Reimbursement
• Prior Authorization specialist