Inside Secrets To DME Billing

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Inside Secrets To DME Billing
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Author(s): 
By Anthony Poggio, DPM

   Many doctors already dispense supplies and durable medical equipment (DME) from their offices for patient use. Others will simply write a prescription and send the patient to a DME provider. This is potentially a lost source of revenue for the practice. Having DME and supplies available in the office is also a great service to the patient.

   Patients love it when they can get X-rays in the office as opposed to going to another facility, waiting for additional services, taking additional time off work, etc. The same applies to dispensing DME. Another benefit of dispensing DME in your practice is you have some level of control over the quality of the items you dispense and can make sure your patient is getting the device you want and not some other company’s version of what you want.

   In order to dispense Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS), one must have a Durable Medical Equipment Regional Carrier (DMERC) license to dispense covered items for Medicare patients. In order to begin this process, contact the National Supplier Clearinghouse at (803) 754-3951 or check out the CMS Web site, www.cms.hhs.gov. Also contact your Medicare regional DMERC carrier to obtain guidelines, fee schedules, etc. The process can be quite lengthy so get started early.

Understanding The Subtle Distinctions Between ‘Providers’ And ‘Suppliers’

   There are three parts to the Medicare Program. Part A essentially covers hospital care while Part B covers physician/provider services. The third component is providing medical supplies and equipment for patients. Keep in mind that in the DMERC system, podiatrists/physicians are not considered “doctors” but are classified as “suppliers.” One can act as both the “provider” requesting the item and the “supplier” of the item.

   One may be a participating supplier or a non-participating supplier. The preferred designation is not affected by the Medicare part B status. You can be a participating provider in Medicare Part B and a non-participating supplier for DMERC or vice versa.

   Being a participating supplier means accepting assignment on all cases. The system pays 80 percent of the allowable fee (after the deductible has been met). One may collect the 20 percent patient portion and any deductible when dispensing the DME item/supply. A non-participating supplier can elect to accept assignment or not on a case-by-case basis. The non-participating supplier may collect the entire fee when they have dispensed the item/supply. The Medicare payment check would then be sent to the patient.

How To Become A DMERC Provider

   At one point, there was a moratorium for issuing new DMERC licenses but that is no longer an issue. There are various requirements to becoming a DMERC provider. These include posting hours of operation on the door of the office, keeping a log of complaints, and having a complaint protocol including a complaint form for the patient to fill out. Suppliers will also get a DMERC Supplier Guidelines binder that they must have available. Suppliers also must contact their malpractice insurance carrier to make sure the DME carrier is listed as a certificate holder on the policy.

   The final step in the application process is an in-person inspection of your office prior to you obtaining your DMERC license. The inspector will ask you to present the various forms mentioned in this article. Failure to have the listed forms available, not posting hours of operation or not having a complaint protocol in place may result in denial of the DMERC license even though the rest of the application is in order.

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Anonymoussays: February 2, 2010 at 11:55 am

We know how to bill Medicare for Therapeutic Footwear, but we have private insurance patients also. Normally, we have to use NDC numbers to get paid by private insurance companies, PPOs, HMOs, etc. for Diabetic Supplies. How can we bill them for Diabetic Shoes and Insoles?

Respectfully

Frank P. Suess
Diabetic Support Program

fpsuess@prescriptionsplus.com

Reply to this comment »
Anonymoussays: March 18, 2010 at 4:48 pm what about pharmacist billing for dme? Is this any different from md's or do's? Reply to this comment »

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