Durable Medical Equipment (DME) is a class of Medicare approved equipment authorized by an enrollee’s physician. Typically, these are products that help with daily activities.
Medicare usually covers this equipment if:
- It is durable, meaning it can be used multiple of times. These products are not usually useful to someone who isn’t sick or injured, and they are meant to be used in the home.
- Designed to help the medical condition.
- Likely to last for at least three years.
In order for the products to be covered by Medicare, the attending physician or primary care provider must prescribe the product, as well as fill out and forward all necessary paperwork to the DME for fulfillment.
If the patient is in a skilled nursing facility (SNF) or are inpatient hospitalized, the DME product is covered under Medicare Part A. Otherwise it is covered under Medicare Part B.
With both original Medicare and Medicare Advantage Plans, the type of equipment covered would be the same. However, the deductible or the patient’s responsibility changes depending on the plan.
So, no matter what kind of equipment is needed – from wheelchairs, walkers and other mobility equipment, to wound care and diabetes supplies – you must check with the individual plans to confirm the patient’s responsibility as well as check the with CMS.gov to confirm the product is indeed covered.
There are other products such as grab bars or adult diapers that are not covered. It is imperative you confirm coverage through the Medicare Schedule at CMS.gov.
Coverage requirements state the product must be medically necessary and prescribed by a physician.
The client must have a prescription, or letter of medical necessity from an office visit, for the product to be covered.
Some products require more supporting documentation than others. You must be sure to check this by product and have the necessary documents to be assured of reimbursement.
Previously, for a Medicare DME Supplier to be reimbursed by Medicare they would have to have won a competitive bid as a specific supplier in a designated area.
As of December of 2018, being a contracted supplier is no longer a requirement. What is required is that you are an approved Medicare provider – meaning you have applied and been issued a DME Supplier PTAN number – Provider Transaction Access Number. You cannot bill for products under Medicare without a PTAN number.
No, you must be separately enrolled as a DME provider which requires a PTAN number.
Although there are many advantages to already being enrolled in Medicare as a physician, in order to expedite the DME supplier enrollment process you would still need to show proof of compliance, proper licensing, and documentation, as well as acquire the DME Supplier PTAN number to be able to bill Medicare.
Acquiring this number can be challenging, as is much of the documentation for Medicare, so it is wise to use someone experienced in this application process.
The DME Consultant can aid you in every aspect of setting up a new DME company or adding it to an existing practice.
Most of the calls we receive are regarding the tedious “application and supporting documentation” required to apply for the DME Medicare Provider Number.
The appropriate application – if you can find it – is 27 pages long, and if so much as a single answer of the numerous questions on those 27 pages is incorrect, it is an immediate rejection, which will delay the application process and will cause that application process to take longer.
CMS may or may not contact you in regards to the deficiencies/error(s). In some cases CMS will call you but generally a letter will be sent to you outlining the issues with the application which can add 30 or more days to receive.
Once the corrections are made you have to start all over, and again you go the bottom of the pile at CMS. Keep in mind other error may be found after correcting the initial errors and the process starts over.
If you accurately complete the application and provide the required supporting documentation without issue, then you will receive on on-site inspection. Applications with errors will delay the process.
If you are not properly prepared for the on-site inspection you will typically receive a letter from Medicare within 30 days outlining the deficiencies. All this again can be eliminated using The DME Consultant.
You will then need to pass inspection to get the final approval to open for business. The inspector can fail the inspection for a very minor infraction such as not having a the correct documentation or incorrect placement of required license on the premises.
Once you pass inspection, your PTAN will be issued on average within 30 days.
- -Braces -Knee, Back, Shoulder, Wrist, Ankle
- -Continuous Glucose Monitors
- -Blood Glucose Monitors & Supplies
- -Canes and Crutches
- -Commodes/Urinals/Bedpan
- -Diabetic Shoes/Inserts-Non-Custom
- -Neuromuscular Electrical Stimulator (NMES)
- -Ostomy Supplies
- -Tracheostomy Supplies
- -Urological Supplies
- -Surgical Supplies
The first step to getting started with OPS is to set up a consulting appointment with a consultant at OPS. During the consulting meeting, we will find what the client’s needs and wants may be and then set up a strategy and plan to meet those demands.
- We provide medical equipment services i.e., braces, catheters, CGM equipment (diabetic equipment)
- Access to patients looking for medical braces (DME Company)
- Consulting services for setting up DME company’s, compliance manuals, pre set up for inspection, preparation
- PPE products, protective mask, gloves, gowns, shields, testing equipment for coved 19, ventilators.
