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.

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.

Ensuring you’re compliant at every step in your DME billing process is very essential to get your claims paid.

Billing according to contractual requirements, local or national coverage determinations, meeting timely filling limits, etc are some of the basic requirements that you could meet and yet be denied a claim.

DME billing software is a low-cost solution that bills, tracks and reconciles DME claims. It also helps reduce the tedious paperwork of managing and arranging papers according to date.

Simplicity: It is very simple and efficient. Every Durable Medical Equipment claim is verified in real time with the database. It also helps to verify the information of the patient such as medical coverage and balances.

The main feature of DME Billing Software includes:

1. Reduces administrative overhead by reducing paperwork.
2. Error free claims filling and billing.
3. Improve efficiency and reduce errors in data submission.
4. Submit DME claims via our secure web portal or your pharmacy system.
5. Eliminate costly manual medical billing service fees.
6. Billing for primary and secondary claims.
7. Eligibility Verification.
8. Flexible Reporting Tools.
9. Experienced and knowledgeable customer service team.
10. Reduced costs in the long run.

Safety and Speed:

• Online DME billing software reduces the workload and speed-up the workflow and is the most secure online medical portal.
• Every patient is provided with a unique user Id and Password to log in.
• The patient’s account will be updated with every minor detail related to the patient along with the doctor’s feedback.
• Moreover, the expertise and representatives of WWS are always there to serve there patient’s query and doubts related to the DME billing Software.

Flexibility:

The DME billing software offers a different level of services to fit the needs and requirements of the doctors, So if you wish to devote more time on patient care and less on billing and payment challenges, then an integrated DME billing software is just what you need.