Friday, July 15, 2016

Coordination with DME Services

Durable medical equipment (DME) refers to any medical equipment used in the home to aid patients to conform to a better quality of living.  It is a benefit included in most insurance policies.  In some cases if the patient has Medicare Part B benefits, they generally will pay for the equipment if it meets certain criteria.

If you or your loved one has Medicare Part B (Medical Insurance) you will find that it covers medically necessary durable medical equipment that your provider will prescribe for you to use in your home.  Only your doctor can prescribe medical equipment for you.  Durable medical equipment needs to meet these criteria:

ü  Prescribed equipment should be durable (long-lasting)
ü  Should only be used for medical reasons
ü  Equipment is not usually useful to someone who is not sick or injured
ü  Should be used in your home

If DME does not meet the criteria listed above, it will not be covered by Medicare Part B and you must find an alternative.  What are some items that fall under durable medical equipment (DME) that are covered?  Here is a list of various items that are included, but it is not limited to:

·      Blood sugar monitors
·      Blood sugar test strips
·      Crutches
·      Commode chairs
·      Hospital beds
·      Patient lifts
·      Suction pumps
·      Traction equipment
·      Walkers
·      Oxygen equipment and accessories

If your supplier accepts assignment, you pay 20% of the Medicare approved amount, and the Part B deductible applies.  Medicare pays for different kinds of durable medical equipment (DME) in different ways.  Depending on the type of equipment, you may need to rent the equipment, you may need to buy the equipment, or you may be able to choose whether to rent or buy the equipment.

You should be advised that Medicare will only cover your DME if your doctors and DME suppliers are enrolled in Medicare.  Doctors and suppliers have to meet strict standards to enroll and stay enrolled in Medicare.  If your doctors or suppliers are not enrolled, Medicare will not pay the claims that are submitted by them.  It is also important to ask your suppliers if they participate in Medicare before you decide to get DME to avoid any discrepancies.  If suppliers are participating suppliers, they must accept the assignment.  If suppliers are enrolled in Medicare but are not “participating,” they have the choice whether or not to accept the assignment.  If DME suppliers do not accept your assignment, there is no limit on the amount they can charge you.  It is important to you as a client to be well informed of your benefits and who is participating and who is not before you make your choice.  You do not want to pay a drastic amount out of pocket if you can avoid it.

You may also have other insurance besides Medicare.  If that is the case and your other insurance pays before Medicare, it may require you to use a supplier that is not a contract supplier. Medicare may make a secondary payment to that supplier.  The supplier must meet Medicare enrollment standards and be eligible to get secondary payments.  As always, for more information review your benefits with all coverage you have. 

With Total Home Health we have all the information that can be made available for you regarding coordination with DME services so that you have all the necessary equipment in your home to use to reach your treatment goals.

No comments:

Post a Comment