Key Findings: 50.0% of the medical directors and staff are currently purchasing between 2.0 and 5.0 products, while 49.0% are purchasing between 5.0 and 10.

It’s simple. They rely on the best available data. Data is the key to overcoming many of the issues facing the DME industry.

DME needs to be treated in the same way as other pharmaceutical products. Prescription records of prescribers should be kept electronically and linked to the patient to be used by the supplier.

To be able to manage inventory effectively, it’s important to understand the unique characteristics of both specialty and traditional medications — for example, how quickly they turn over in the supply chain and how many days are needed to reach the end user.

“These complexities are not new, but we have to understand how to manage them better as we have a more technologically advanced delivery system,” said Gopal Takru, president of Medco Health Solutions.

To create a solution for our DME providers, WWS provides a proprietary data analytical model to help DME providers in making the right decisions on product selections and inventory levels in a landscape that is changing every day.

However, you don’t need to be a programmer to reap the benefits of data analytics. In fact, with the right tools and resources, anyone can become a data-driven marketer. And that’s exactly what WWS accoamlisehes with the data analytical model. 

Whether you’re a seasoned marketing professional or a DME newbie, its important to obtain valuable insights to increase your revenue and better engage with your customers.

DME companies are realizing the value of analytics and are using data to drive decision-making for improving outcomes and lowering costs. More than half of providers are using analytics to increase efficiency, according to a recent survey from the DME Association of Florida.In addition, 84 percent of providers reported that they use analytics to reduce costs and improve outcomes.

In the past, charts, graphs and spreadsheets were the primary tools to view data, but with the increased demand for better data analysis, a more modern and innovative approach is needed. The need for data visualization is also present in many other industries, particularly in ones that require customization of a product or services to a specific customer. In the DME industry, being able to quickly and easily provide a customer with a visual representation of their data has maximized customer satisfaction and potentially boosted profits.

How DME Companies can thrive in tough times?

Several years ago, durable medical equipment competitive bidding was instituted by Medicare and the impact has been dramatic. Competitive bidding was so disruptive to the healthcare market that over 40 percent of DMEs are no longer in existence. Many smaller DMEs that could not successfully compete sold their assets, restructured their business, or simply closed their doors, with the owners moving on to new pursuits.

While these 40 percent of DMEs were in denial or frozen like a deer in headlights, other DMEs companies saw this market disrupted for what it was an opportunity to be exploited with growth and increased profitability.

In our national DME merger and acquisition practice, we’ve seen a number of success stories of companies that have both survived and thrived in this increasingly competitive environment. Here’s what they did:

1. They ruthlessly assessed the healthcare marketplace.

Successful DME entrepreneurs realized quickly that healthcare is now being shaped by economics, managed care, rapid innovation, strongly stated customer preferences, digital marketing, and new direct access to DME products. They then made a commitment to adapt to these changes rather than pretend they weren’t taking place.

2. They partnered with investors and capital.

Successful DME entrepreneurs scrapped the traditional “go it alone” strategy in favor of a new affiliation model, where competitors actively partner with one another in selected areas. They also brought in new investors, especially private equity groups that had abundant financial resources and saw an opportunity for disruptive innovation.

3. They adopted a millennial perspective.

Rather than the lethargic approach characteristic of many DME operators from the Baby Boomer generation, successful DME entrepreneurs have acted with a sense of urgency and agility that’s characteristic of high-tech firms, where most of the key employees are from the millennial generation.

4. They sharpened their strategic clarity.

Traditional DME companies often had a general sense of their strategic goals rather than a precise understanding of what would be necessary to succeed in a changed and changing marketplace. The most successful DME entrepreneurs set aside their historic biases, systematically assessed their risk/benefits, identified the resources necessary to succeed, and then aligned those resources strategically prior to taking action.

5. They focused on precise execution.

In the past, DME companies often had good, but general plans for the future. However, few were able or willing to execute those plans with precision. The DME companies that thrived acted with conviction, evaluated their results, and made course corrections in order to keep on growing and diversifying. They were and are ambitious, in the best sense of that word.

6. They targeted their offerings.

Traditional DME companies tended to offer a full line of products, regardless of whether those products were profitable or in high demand. By contrast, today’s progressive DME companies tend to “drill down to core offerings,” all the while paying attention to cross-selling opportunities. This allows them to quickly eliminate under performing products, thereby increasing profitability.

7. They’ve learned to learn quickly.

In order to take the actions described above, successful DME companies have learning quickly from their mistakes and successes alike, incorporating those lessons into new offerings and new initiatives. Mostly, they’ve learned that the DME market is shifting, like the rest of the healthcare industry, to a value-based, outcome measured model.

8. They’ve become fanatical about measurement.

Funding entities and payers, whether public institutions, managed care organizations, commercial insurance, or even consumers who pay cash, want to know about observable outcomes and value in terms of their healthcare. Healthcare companies that can’t deliver these outcomes and value or can’t communicate them effectively simply can’t compete in this rapidly changing market.

Conclusion:

The disruptive approaches have helped DME companies survive and thrive despite the monumental changes in the industry. They also offer lessons learned that can guide you now and in years to come. Further changes are inevitable so keeping an agile perspective on the future will serve you and your DME well.

If you would like to know more about this article, you can reach us directly at support@wonderws.com

Unless you’re a healthcare worker using durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) or are a home healthcare company, you probably have no idea what Medicare’s DMEPOS Competitive Bidding Program (CBP) is or how it affects healthcare equipment suppliers and patients.

Frankly, it’s been a thorn in the sides of many DMEPOS companies for years. Imagine their glee when the Centers for Medicare & Medicaid Services (CMS) proposed changes to the program.

All Medicare Durable Medical Equipment, Prosthetics, Orthotics, & Supplies (DMEPOS) Competitive Bidding Program contracts expired on December 31, 2018. As of January 1, 2019, there is a temporary gap in the entire DMEPOS Competitive Bidding Program that CMS expects will last until December 31, 2020. 

During the temporary gap, any Medicare enrolled DMEPOS supplier may furnish DMEPOS items and services to people with Medicare. In most cases, people with Medicare won’t need to switch suppliers on or after January 1, 2019. 

• Medicare beneficiaries may receive DMEPOS items from any Medicare-enrolled supplier until such time as new CBP contracts go into effect.
• When competitive bidding resumes, it will be under new program rules, as discussed below.

Future Competitive Bidding Program Rules

In a final rule scheduled to be published on November 14, 2018, CMS adopted a number of “market-oriented reforms” and technical policy changes for future rounds of competitive bidding. According to CMS, the new rules will simplify the bidding process, preserve beneficiary access to items and services, and make the DMEPOS CBP more sustainable.

Of particular note, CMS has finalized its proposed “lead item pricing” methodology. Rather than bid on each item/HCPCS code in a product category for each competitive bidding area (CBA), suppliers will submit a single bid for the item in the product category designated by CMS to have the highest total nationwide Medicare allowed charges.

Proposed Changes Are a Win/Win

According to a CMS Newsroom Fact Sheet, “Beginning on January 1, 2019, beneficiaries may receive DMEPOS items from any willing supplier (until new contracts are awarded under the DMEPOS CBP).”

Home healthcare supply companies are breathing a big sigh of relief about the proposed changes.

The proposed changes will benefit to small DME companies by allowing them to market their products and company to providers, facilities, and nursing agencies without limiting their customer base to non-Medicare insurances.

Even though Medicare fee schedule is low, it opens up the market to more customers and creates a fairer playing field for all companies, which will result in better service to beneficiaries.

For those companies who didn’t have contracts due to CBP, but now do, the only downside is they’ll need to jump back through the hoops of government regulations to get their Medicare claims paid.

To learn more about Medicare’s Temporary Gap Period or the future of Medicare Competitive Bidding, follow the link http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/DMEPOSCompetitiveBid/index.html?redirect=/DMEPOSCompetitiveBid/

Every year 14 November is marked as the World Diabetes Day. As we prepare to celebrate World Diabetes Day in November, ask what you can do to raise awareness, to get diabetics supplies and other related consumables to patients who find their lifeline cut off or disrupted as refuges and displaced people.

Educate the patients about Diabetes supplies and to save one’s life. Thousands of people living with diabetes that need to travel long distances to access the life saving medicines/supplies they need.

Diabetes Supplies to Have When You Leave Home

Diabetes travel kits are important to have on hand whether you are going across the country or across town. The only difference is the quantity of supplies you take along. Unfortunately, most people with diabetes do not leave home prepared to deal with the range of situations they might confront.

So, what are those essential diabetes supplies that you should always have within reach? Here is a checklist.

Travel Checklist:

Glucose meter

Your glucose meter should be with you at all times, even if you are just going to the grocery store. You never know when you night need to check your blood sugar.

Extra battery for meter (and insulin pump if you use one)

You don’t want your meter to lose battery power right before you sit down to nice meal at your favorite restaurant. Glucose meter batteries differ by manufacturer. Learn the type of battery your meter uses and keep a spare in your testing kit. Insulin pumps will typically let you know when your battery is low, but it doesn’t hurt to carry a spare.

Test strips. 

Always keep an ample supply of test strips with you in case you need to test more frequently than you anticipate.

Lancing device and lancets.

Carry at least the number of lancets needed for an entire day of testing. It is preferable to not reuse a lancet since it is not sterile after a single use and is more dull, which increases the discomfort.

Insulin

If the weather is warm, you might also want to include an insulated bag with some cold packs to keep your insulin cool.

Syringes (or other insulin delivery device).

If you are using syringes, take at least the average number you would need for an entire day, preferably more.

Keytone strips

You may only use these rarely while away from home but it’s always good to have them. The foil wrapped strips last longest.

Glucagon emergency kit

Glucagon is used in emergencies when blood sugar drops so low that you are unconscious or can’t swallow. Learn how to use it, teach those closest to you how and when to use it and don’t leave home without it.

Fast-acting glucose

You should always carry a small supply of fast-acting glucose with you at all times in case you have a low blood sugar reaction. Glucose tablets and glucose gels are available for this specific purpose. You can keep these in your purse, coat pocket, briefcase, or glucose testing kit.

Medical identification

It is a good idea to wear some sort of identification that indicates to emergency personal that you have diabetes. If you are in an accident or found unconscious, this alerts medical personnel to address your diabetes needs immediately. The most common types of ID are bracelets and pendant.

Health history

A health history can be extensive or basic but it is always wise to carry one with you. A basic history includes known conditions (including type 1 diabetes), allergies, medications you are taking (include vitamin and herbal supplements), emergency contact information, healthcare providers and their contact information. Update this information at least one each year.

This might sound like a lot of stuff to carry with you, but having these things on hand will give you peace of mind and allow you to be prepared should the unexpected occur. A number of products are designed to put all of these items in one place for easy portability.

Diabetes might be a new diagnosis for you, but not for us. Our staff has decades of experience helping folks understand the most efficient, least painful way to live full lives with Diabetes. Let us help educate you and your family on everything from pain-free testing to syringe care and safety.

Contact us If you need any assistance to reach your DME Providers for your Diabetes Supplies.

Stay Healthy, Be Diabetes Free.

CMS Proposed Polices and Payments rates for End-Stage Renal Disease providers for CY 2015

On July 2, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after January 1, 2015.

• This proposal would introduce new quality and performance measures to improve the quality of care by outpatient dialysis facilities treating patients with end-stage renal disease and proposes to implement the Affordable Care Act mandate to bring more competitive bidding for durable medical equipment.
• The rule also proposes changes to the ESRD Quality Incentive Program (QIP), including for payment year (PY) 2017 and PY 2018, under which payment incentives are applied to dialysis facilities to improve the quality of dialysis care.
• This rule also addresses issues related to the coverage and payment of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).

A separate fact sheet addressing the payment provisions of the ESRD PPS for CY 2015 can be found here: http://www.cms.gov/Newsroom/Newsroom-Center.html.

CMS Updates to Policies and Payment Rates for End-Stage Renal Disease Facilities for CY 2016 and Changes to the ESRD Quality Incentive Program

On October 29, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a final rule to update payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after January 1, 2016.

• The ESRD final rule is one of several rules for calendar year 2016 that reflect a broader Administration-wide strategy to provide quality care at lower cost by improving ways to deliver care, pay providers, and use information.
• Provisions in these rules are helping to move our health care system to one that values quality over quantity and focuses on reforms such as measuring for better health outcomes, focusing on disease prevention, helping patients live successfully at home, helping manage and improve chronic diseases, and fostering a more efficient and coordinated health care system.

To read the complete update click the link https://www.cms.gov/newsroom/fact-sheets/cms-updates-policies-and-payment-rates-end-stage-renal-disease-facilities-cy-2016-and-changes-esrd

CMS releases final rule for 2017 ESRD payment bundle

The Centers for Medicare & Medicaid Services issued a final rule on Oct. 28, 2016 that updates payment policies and rates for the End-Stage Renal Disease Prospective Payment System for 2017. The final rule also made changes to the ESRD Quality Incentive Program (QIP), including payment years 2019 and 2020.

Changes to the ESRD PPS for 2017

• The finalized CY 2017 ESRD PPS base rate will increase $1.16 to $231.55, compared to the 2016 rate of $230.39.
• The 2017 home and self-dialysis training add-on payment adjustment will be $95.60, an increase of $45.44, compared to the 2016 add-on of $50.16.
• CMS will provide coverage and payment for renal dialysis services in 2017 by an ESRD facility to an individual with acute kidney injury. Under the law, the payment will be the amount of the ESRD PPS base rate, as adjusted by the wage index.

CMS Updates to Policies and Payment Rates for ESRD Prospective Payment System, Quality Incentive Program, and Payment for Renal Dialysis Services Furnished to Individuals with Acute Kidney Injury for 2017

On October 27, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after January 1, 2018.

• The ESRD PPS rule is one of several rules for calendar year (CY) 2018 that reflect a broader Administration-wide strategy to support the patient-doctor relationship in health care and promote flexibility and innovation in the delivery of care.
• In addition, this rule finalizes updates to the acute kidney injury (AKI) dialysis payment rate for renal dialysis services furnished by ESRD facilities to individuals with AKI, as well as updates to the ESRD Quality Incentive Program (ESRD QIP), including for payment years (PYs) 2019, 2020, and 2021, under which payment incentives are made to dialysis facilities to improve the quality of care that they provide.

The ESRD PPS rule is one of several rules for calendar year (CY) 2018 that reflect a broader Administration-wide strategy to support the patient-doctor relationship in health care and promote flexibility and innovation in the delivery of care.

CMS is committed to transforming the health care delivery system – and the Medicare program – by putting a strong focus on patient-centered care, so providers can direct their time and resources to patients and improve outcomes.

To know about the changes read the complete text https://www.cms.gov/newsroom/fact-sheets/cms-updates-policies-and-payment-rates-end-stage-renal-disease-prospective-payment-system-quality

CMS release ESRD/DMEPOS Competitive Bidding Program Temporary Gap Period Announcement for 2019

Centers for Medicare & Medicaid Services (CMS) has released its final End-Stage Renal Disease (ESRD)/ Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) rule, which contain some, but not all of the additional competitive bidding and reimbursement reforms for which HME stakeholders have been calling.

On November 1, 2018, the Centers for Medicare & Medicaid Services issued a final rule that updates payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after January 1, 2019.

1. This rule also updates the acute kidney injury dialysis payment rate for renal dialysis services furnished by ESRD facilities to individuals with AKI, and finalizes changes to the ESRD Quality Incentive Program.
2. The policies in this final rule aim to increase access to items and services for patients, drive competition, increase affordability, encourage facilities to adopt transformative and innovative therapies, and reward ‘out of the box’ ideas that will produce long-term savings that can be passed on to patients.

This rule also finalizes changes to bidding and pricing methodologies under the:

• Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)
• Competitive Bidding Program (CBP);
• Adjustments to DMEPOS Fee Schedule amounts using information from competitive bidding for items furnished on or after January 1, 2019.
• New payment classes for oxygen and oxygen equipment and a new methodology for ensuring budget neutrality for oxygen payment classes; and special payment rules for innovative multi-function ventilators or ventilators that perform functions of DME.

Starting January 1, 2019, there will be a temporary gap period in the entire DMEPOS CBP that CMS expects will last until December 31, 2020. During that time, Medicare beneficiaries may receive DMEPOS items from any Medicare enrolled DMEPOS supplier and in most cases, they won’t need to switch suppliers.

In addition, in the proposed rule, CMS solicited comments in a request for information (RFI) on the gap-filling process for establishing fees for new DMEPOS items.

Footnotes:

CMS is committed to transforming the healthcare delivery system and the Medicare program by putting a strong focus on patient-centered care, so providers can direct their time and resources to patients and improve outcomes. The ESRD PPS and QIP DMEPOS final rule is one of several rules for calendar year (FY) 2019 that reflect a broader Administration-wide strategy to relieve regulatory burdens for providers, support the patient-doctor relationship in healthcare, and promote transparency, flexibility, and innovation in the delivery of care.

In this final rule, CMS summarizes comments it received in response to an information solicitation on how the gap-filling process could be revised in a way that complies with the exclusive statutory payment rules for DMEPOS, but also prevents excessive overpayments or underpayments for new technology items and services.

We encourage you to reach us if you have any questions at support@wonderws.com

Times are tough for smaller DME suppliers, but the changing healthcare landscape is also impacting larger entities.  Rising costs and shrinking reimbursements are part of the problem, but suppliers are also subjected to the vagaries of changing and even conflicting policies between Medicaid and MCOs (Managed Care Organizations).

The post is about why mergers and acquisitions provide solutions for durable medical equipment suppliers, taking some of the heat off in a challenging market.

Bigger Is Better

It’s unfortunate to note that the laws of the jungle apply in a market like the one we’re operating in, with big fish eating little fish in a system which has emphasized cost-cutting through competitive bidding.

In the case of DMEPOS (durable medical equipment, prosthetics, and orthotics supplies), a competitive bidding process is now in place but not everywhere.  The intention of the legislation behind CBAs (competitive bid areas) was to improve access and affordability for end users, but the impact on suppliers has been substantial.

Winners in CBA bids offer not only the lowest price but meet certain criteria for quality. Larger companies are better equipped to do this, with the ability to absorb pricing which proves less sustainable for smaller companies.

This is where bigger is better, as the offer to merge with a larger entity allows the smaller fish to survive, albeit in a new configuration.  Smaller suppliers augment their market presence and are enabled to offer a higher quality of care for the patients they serve, both old and new.

Mergers of this nature benefit both parties, allowing the larger company to benefit from the network of the smaller acquisition and the smaller company to benefit from the streamlined processes and market viability of its new mothership.

The Wave of the Future

Healthcare reform is ongoing and that’s unlikely to change for the foreseeable future.  As new challenges arise, this reality will further impact smaller suppliers, sending them into the arms of the DME industry’s big fish.

When going out of business isn’t an option, merging with a larger entity is an attractive option. While it may seem as though something has been lost, it must be remembered that something has also been gained.

Joining the ranks of a larger company serves to maintain existing legacy while benefiting the people who’ve worked to create it and adding value to the DME market with improved quality and patient service.

The sector has enjoyed steady growth in recent years, as well as an uptick in mergers and acquisitions, with names like Johnson & Johnson acquiring smaller suppliers, expanding their market share and creating new synergies which benefit patients.

Contact Us or Schedule a live demo http://localhost/main-site-update/live-demo/ to find out more.

Pharmacy accreditation is not just about revenue streams it’s also about being able to service your community.

Many pharmacies are exploring the issue of accreditation.

They wonder:

What will it take? 

Will it be worth the time, effort, and investment?

Like other DME retailers, pharmacies that want to sell Medicare-reimbursable products first need to become accredited. The reason, according to Rhonda Pearce, director of operations for Healthcare Quality Association on Accreditation (HQAA), is that accreditation ensures that an organization is operating at a higher level of quality due to having more uniform practices and processes in place.

Why Would a Pharmacy Want to Be Accredited?

Payer agreements may require accreditation in order for the pharmacy to participate in certain programs. Or, they may offer a financial incentive, such as a per claim “bump” for those pharmacies that are accredited.

Pharmacies may also use their accreditation as a way to set themselves apart from their competition when marketing themselves to patients. The equivalent of the Good Housekeeping Seal of Approval, accreditation can reassure patients that their pharmacy and their pharmacist have gone the extra mile and are fully prepared and capable of handling their care and information in a safe manner.

Pharmacy accreditation helps:

 Create policies and procedures that follow CMS quality standards, federal and state guidelines, and good business practices. Implement policies and procedures throughout the organization. Ensure all staff is involved in the accreditation process

Once all policies and procedures are implemented, a site visit will be performed to ensure the organization is following their policies and procedures, as well as regulations. A surveyor visit validates that what an organization indicates on paper is what their practices are and are truly implemented as observable processes.

The overall accreditation process for pharmacies is similar to non-pharmacy DME retailers, and their motivations for going through the process include creating new revenue streams, as well as serving the needs of their community.

Considering Pharmacy Accreditation

A lack of industry data on reimbursable sales makes it difficult to pinpoint how many pharmacies become accredited in pursuit of generating more revenue streams. But knowing how accreditation helps build your business is a motivating factor for going through the process.

Accreditation is the gateway to entry in getting a Medicare Part B number for DME. The process, she explains, is directly tied to billing privileges and the products that pharmacies provide. Important to remember is that the accrediting organization reports the products that the pharmacy gets accredited back to CMS. Therefore, knowing your business and customer’s needs is paramount to successful accreditation.

Aside from Medicare revenue, in some states require that if you want to do anything in Medicaid or DME, you also have to be accredited for Medicare. In addition, if the pharmacies want to bill some private insurance, they could require accreditation. So even if you don’t want to compete in the Medicare market, you are still other reasons to get accredited.

Steps towards Accreditation

Before you start the process, first and foremost make sure you understand why you’re getting accredited. A lot of company’s are just assuming they need to get accredited without doing any research. Know what your accreditation goals are.

From there, it’s about who’s on your team. Make sure you have the staff to comply with all the rules, regulations and data that is needed for accreditation. You can’t just say, ‘I’m going to get accredited,’ and expect somebody to do it. You have to have the staff to help you get ready.”

If you’re a new pharmacy, you won’t qualify for the exemption, but if you have been a supplier for at least five years, you should look into whether you qualify for an exemption to accreditation.

 Conclusion:

Accreditation will provide you opportunity, whether it’s to get into Medicare or whether it’s to get in to other networks. It will give you opportunity and provide you walk-in business that you might not get otherwise or maybe you’re doing it just to help support the community.

Schedule a free demo http://localhost/main-site-update/live-demo/ to learn more about Accreditation.

If you’re Suppliers visit our page to improve DME Accreditation Quality & Performance Documentation http://localhost/main-site-update/dme-accreditation-improve-performance-documentation/

It is important for you to take charge of getting your DME.  You know best what you need and it is your responsibility to make sure you get equipment that will work for you. This process can go more smoothly if you attend to the details

1. Who can get DME?
2. What are the steps in getting DME paid for?
3. What are the most common reasons for denial of payment?

What is Durable Medical Equipment?

According to the Centers for Medicare and Medicaid Services, is a health care device that helps a person with a mobility limitation to conduct activities in their home and community.  This includes such items as wheelchairs, walkers, oxygen tanks, communication devices and hospital beds. The Centers for Medicare and Medicaid Services defines durable medical equipment  as any equipment that:

1. Can withstand repeated use
2. Is not useful to a person who does not have an illness or injury
3. Is appropriate for use in the patient’s home

It’s strange how they think we are all sick and stuck at home, and that getting around is a medical issue!

What Are Some Examples of DME?

 DME is considered to include:           

• Equipment that can help you to get around more easily such as canes, crutches, walkers, wheelchairs or scooters.
• Equipment that you may need to care for yourself at home such as hospital beds, raised toilet seats, oxygen tanks, or machines that make breathing easier.
• Equipment that can help you to hear or see better like hearing aids or magnifiers.

DME does NOT include:

• Equipment that is considered “items of personal convenience” or reusable items, such as rubber gloves, catheter tubing, or irrigation kits.
• Equipment that is not considered to be for “medical use,” such as grab bars, lifts or shower chairs.
• Equipment used exclusively outside of the home is often labeled recreational or “used to pursue leisure interests” and may not be covered as DME.

So getting around is a medical issue, but taking a shower is not?? Who writes these regulations?

Who can get DME?

People who are admitted to hospitals and skilled nursing facilities for surgeries, illnesses or injuries will get the equipment they need before being discharged.  In these situations, the equipment that people receive depends on why they were in the hospital. For example, if you go to a hospital for a hip replacement, the hospital will probably send you home with a walker and a raised toilet seat.

The process for getting DME without being in the hospital is different. You can pay for any piece of durable medical equipment yourself. However, because it can be expensive, people usually use their health insurance to pay for DME. Insurance carriers have different guidelines for what equipment they will pay for.  For example:

Medicare pays for DME when you:

1. have Medicare part B;
2. have a doctor prescribe a covered item of DME; and
3. need the device in order to function in your home.

How Do You Get The DME You Need?

Once you have decide that DME is the right choice for you, there are several steps involved in getting it.  If you are able to pay for the equipment yourself, you can go to any DME vendor in your area that has the equipment you would like and you can purchase it.  Depending on whether it’s in stock and available, you may be able to pick up the DME immediately or usually within several weeks. Follow these steps to get your DME.

What is a DME vendor?

A DME vendor is a company that specializes in DME.  DME vendors have staff who are experts in equipment. Some are physical therapists (PT), occupational therapists (OT) and Certified rehabilitation technology suppliers. The vendors work with the companies that make the equipment as well as your insurance carrier.        

How do you find a DME vendor?

Your health insurance carrier may allow you to choose your own DME vendor. However, your insurance company may have a recommended DME vendor, and they may only pay for equipment you get through this vendor. Many times the DME vendor who has the contract for your insurance may not be the best qualified to handle your needs. Ask your insurance carrier what you may do if you are not satisfied with their vendor. You are the consumer!

If you have a choice of vendor:

1. Your doctor can recommend a DME vendor.
2. Ask your friends if they can recommend a DME vendor in your area.
3. Telephone your local drug store, pharmacy or medical supply company and ask if they know of DME vendors in your area.

Who Follows Up On Your Order?

You do. To make sure everything has been filed and the process is going smoothly, you should follow up with your DME vendor. Remember, they handle hundreds of requests so you also will want to follow up with Medicare, Medicaid or your private insurance company directly to check on the status of your claim.

You should keep a copy of every form filed with your request and get any claim numbers and all contact information. Make sure your doctor knows also how long the process is taking and what is happening so that he/she will be able to assist you in following up when necessary.

Conclusion: 

Getting the right gear for your unique needs can be a challenging and time consuming process.  Using the information provided here and attending to the details can help make the process go a little more smoothly and reduce the chance of having your request denied.  It is important that you take charge of getting your DME. It is your responsibility to make sure you get the right gear.

If you need any help in contacting DME Vendors Contact us. Our team will guide and support you with selecting of right DME suppliers for your Medical issues.

For every argument about sticking to your core mission, there’s a competing philosophy that says you must adapt to the times and embrace change.  Your industry and the business owners who comprise its ranks need to be open to change and re-evaluate their businesses and how they operate.

Reimbursement changes as well as technological advances, coupled with the changing styles of consumerism, how people shop, and the fact that customers are willing to pay for an increasing amount of their healthcare all make the environment ripe and ready for a change!

So, What is a DME supplier to do?  What changes are trending in the industry that you can consider? 

Here’s a list of some common and some not-so-common trends in how businesses are changing and adapting to the new reality that is healthcare:

1.  RETAIL:  

• For many years, retail was something many if not most DME organizations avoided.  Your customer service reps were too busy answering phones to wait on customers in a showroom. 
• Perhaps because you’re more likely to be spending your own money (as opposed to insurance, Medicare, etc.), folks are more willing to visit your DME stores than before. 
• Caregivers and loved ones are increasingly involved in the purchase/search for medical care, products, and supplies. 
• You’ll need staff to handle the traffic and provide customer service along with sales and you’ll need a location that is in a convenient part of town.  But, the payoff can be considerable. 
• Most DME organizations that provide retail services report that they get more traffic in their stores than in the past and the trend is increasing.

2. MAIL ORDER: 

• If you don’t think mail order services are worth investigating, consider Amazon. 
• They’ve literally changed the way America shops. 
• Malls are closing across the country because of this trend, and if you don’t believe that this method can work for healthcare, remember that Amazon is ramping up a mail order pharmacy. 
• Their delivery model is efficient and tough to compete with.  But they don’t have licenses and credentialing to provide DMEPOS and you do! 
• Mail order has become an effective way to distribute urological, enteral products, CPAP masks and supplies, diabetic testing materials, and a whole host of other products.

3. HOME MODIFICATION

• Who better than a DME that sells grab bars, bathroom safety equipment, and mobility devices to install stair glide systems, build appropriate and safe ramps for home access, and make a person’s bathroom safe for someone that has difficulty moving around?  you know the products and you often have a built-in database of potential customers. 
• Many of the same referral sources that send a patient who needs a wheelchair to a DME are also looking for a good, reliable home modification company to send new customers to.

4. SPECIALIZE:

• As DME owners, you need to constantly re-evaluate which product lines and which services are working and which aren’t.  Gone are the days that we can be “all things to all people.” 
• If your core business is respiratory products such as PAP and oxygen but you added bent metal DME and general medical supplies over the years, would it make sense to go back to your core business? 
• Bulging off product lines that are no longer profitable can help us focus our energies on products and services that are still worthwhile.

5. GENERALIZE:

• For many organizations, narrowly focusing on a specialty makes sense.  For others, however, adding additional product lines might make more sense.  If you have set up a business to deliver hospital beds, you probably have a warehouse, an area to clean and repair equipment, delivery personnel and vehicles, and customer service to answer the phones when these hospital bed customers call you with issues.  Why not put these resources to work for you in other areas?  The goal here isn’t to become all things to all people but rather to keep your staff busy, and utilize the skills and reputation you’ve developed in other, complementary areas.

The most important aspect of reinvention is to think it through.  What’s good for other DME organizations isn’t necessarily good for you!  But staying open to change and willing to consider other options can open a whole new avenue of opportunity and hopefully a better income stream.

Time to change your DME Business model. Contact us for more information +1(302) 613-1356

Items you will need

• Taxpayer identification number
• National provider identifier
• Bank account information
• Form CMS-588
• NSC number, provider transaction access number or Medicare identification number (if already enrolled)

Take a visit to the National Plan and Provider Enumeration System website and apply for a user ID and password.

Check your email for an approval notification from the U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services. After you have received notification that you have been granted approval via email by CMS, go to the next step.

• Visit the Medicare Enrollment for Providers and Suppliers,
• Medicare Provider Enrollment, Chain and Ownership System, or PECOS, website.
• Log in, download and fill out the security consent form

The security consent form contains separate areas and signature requirements for the supplier organization and employer organization. The data you enter in both sections should be the same if you are requesting approval to submit the enrollment applications, and you are an authorized official employed by the supplier organization. Sign and date the security consent form in both places and mail it to the CMS External User Services Help Desk.

• Check your email for notification that your security consent request has been approved.
• Log in to the Internet-based PECOS system and fill out the enrollment application form CMS-855. Click “Continue” and follow the on-screen prompts to complete the application
• Print a copy of the enrollment application for your records.
• Mail any supporting documentation as recommended by PECOS.
• Print, date and sign the certification statement and mail it to the National Supplier Clearinghouse – Medicare Administrative Contractor within one week.
• Check your email for a notification that your Medicare supplier form enrollment application form was successfully transmitted online.

Wait at least 15 days, then log in to the PECOS system to check the status of your application. If you have supporting documents to mail, count 15 days after you have mailed those documents before you check the status of your application.

Points

• You must be an authorized official of the organization you want to register as a Medicare supplier to complete these steps.
• Allow several weeks to complete the enrollment process. Alternately, you could fill out the paper version of the Medicare enrollment application, form CMS-855S, in lieu of applying online.

CMS recommends users change their PECOS password at least once a year.