Inside Secrets To DME Billing

Author(s): 
By Anthony Poggio, DPM

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.    Group practices will get a license for the group as an entity. However, if there is more than one doctor sharing an office space (i.e. two solo practitioners sharing office space), only one may get a license. The other doctor may refer patients to the doctor/supplier holding the DMERC license for dispensing of DME items. Lastly, if you do not use your license for four consecutive quarters, it will expire and you will have to reapply for your DMERC license.    If you dispense and bill a Medicare beneficiary cash for any covered items and you do not have a DMERC license, you are in violation of Medicare policy. This is true even if the patient agrees to pay for the item. If the patient were to complain to Medicare, you must refund the patient the money he or she paid for the item in full and the patient gets to keep the item. This may also prevent you from getting a DMERC license in the future. If you do not have a DMERC license, send the patient to a DME supplier or another podiatrist who has a DMERC license.    For non-Medicare carriers, check with each plan in which you participate to see what regulations the insurer may have regarding the dispensing of DME items from your office. Many HMOs require the use of preferred vendors. Also be aware that charging patients for otherwise covered DME items/supplies may put you in jeopardy of violating your HMO contract.    In addition, check to see what provisions there are for “urgent” situations. Invariably a patient will show up in the office at 4:45 p.m. on a Friday with some trauma that may require dispensing a cam walker. However, the insurance offices may be closed at that time, which would hamper your ability to obtain any authorization. Many companies do not issue retro authorizations or at least make the process very difficult and time consuming. Therefore, one may need to adjust the treatment plan to care for this patient in order to get him or her through the weekend until obtaining a formal authorization for a DME device. This may require the use of an Unna Boot or a formal cast instead of the cam walker. Keep in mind that regardless of the hassles of an authorization process, we still must provide services within the standard of care.

Comments

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

what about pharmacist billing for dme? Is this any different from md's or do's?

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