Chapter 28 – What Is Durable Medical Equipment (DME)?

DME stands for durable medical equipment. It is a reusable device that provides a therapeutic benefit to the patient for a long period of time.

It is more expensive than an alternative service

DME is a type of medical equipment that is used to treat or manage certain conditions. DME must not be more expensive than an alternative service, and the item must be at least as effective in producing the therapeutic effect for which it is used. To qualify for this type of service, the individual must provide detailed information regarding the diagnosis, functional limitations, past experience with related items, and other factors. The MPTAC has also reviewed and clarified the coding and discussion sections of the Medicare and Medicaid programs.

Medicare Part B covers durable medical equipment

Depending on your health insurance coverage, Medicare Part B can cover the cost of a wide variety of DME. Whether you need a wheelchair, a cane, or other equipment, you can receive coverage for these items. Most types of DME are covered by Medicare, but there are exceptions. If you’re in need of a breathing therapy device, Medicare will usually cover the cost of its maintenance and repair. The cost of professional repair is also covered by Medicare, but most cost is only covered up to 80% of the total cost.

Depending on your specific needs, your Medicare Advantage plan may cover the cost of durable medical equipment. It may have limitations, however, which you’ll need to check. Depending on your plan, you may need to obtain prior authorization before you can use your new equipment. Also, some plans require that you use a Medicare-approved supplier. For more information on the equipment that Medicare Part B covers, contact your plan’s provider directly.

In addition to supplies, Medicare also covers the cost of certain reusable medical equipment. Examples of such equipment include walkers, wheelchairs, hospital beds, and oxygen equipment. Medicare Part B will cover the costs of these products for you if you have a medical need for them. Your doctor will determine what kind of equipment you need based on your physical condition, the extent of your disability, and how easily you can use it. Once approved by your doctor, your DME will be covered. However, you must pay a Part B deductible in addition to any cost that you may incur.

It is a long-term, reusable device that provides a therapeutic benefit to patients

There are many different types of durable medical equipment that are prescribed for patients. These include mobility aids, personal care items, prosthesis, orthotics, and oxygen equipment. Mobility aids are often prescribed for elderly patients, as they assist them with daily tasks. Other types of durable medical equipment include wheelchairs, walkers, and bath seats. All of these products can be prescribed to help patients with various tasks and are often covered by insurance.

Many patients choose to self-diagnose their medical conditions and purchase their own DME products. This can include a shower chair or cane. Some patients even purchase these devices without a prescription, paying the full price for the equipment. However, this method is not recommended because it might not be covered by insurance. As a result, patients are more likely to encounter financial hardships or have to pay for the products out of pocket.

In addition to the many benefits of durable medical equipment, they also offer a significant financial benefit. The majority of DME costs are covered by Medicare, which means that the supplier will handle any repairs or maintenance that are necessary for the device to remain in good working condition. DME costs can vary widely by plan type, and Medicare Advantage plans may have different rules about how to cover repairs. However, Medicare typically covers a basic DME, but beneficiaries may have to pay for upgrades or other special features.

It is paid by an insurance company

If your employer pays for durable medical equipment (DME), you may have to worry about how to get it repaired and maintained. Although Medicare pays for most DME costs, some plans may require you to pay coinsurance. Coinsurance is a percentage of the cost of a device that the insurance company considers necessary. For example, a policy may require you to pay 80% of the cost of a breathing machine, but only 20% if you rent it.

Many DME items are available over-the-counter. But some require a prescription from a doctor. Many items are available online and may be covered by insurance. You should ask your doctor about specific DME items that may be covered by your plan. To make sure you get the right one, you can do some research online. For example, Amazon shows which items are eligible for HSA or FSA cards.

Medicaid is another source of durable medical equipment. But unlike Medicare, Medicaid covers many types of equipment if they are medically necessary and cost-effective. While the definition of “durable medical equipment” varies from state to state, it is often similar to Medicare. Many Medicaid programs cover 100 percent of the cost of home medical equipment. When comparing Medicaid and private insurance coverage, make sure to look for the one that covers your needs and your budget.

It requires a physician’s prescription

When purchasing durable medical equipment (DME), patients must obtain a physician’s prescription before they can be used. While some medical equipment is self-diagnosed, such as shower chairs and canes, a physician’s prescription is needed in many instances. Self-diagnosis may cost the patient the equipment’s full price and the insurance coverage may be limited. If you want to avoid this, make sure you get a prescription from your doctor first.

Most DME suppliers must maintain a physician’s prescription on file. These documents are not part of the patient’s medical documentation, but rather an order from a treating physician. It is very important to note the appropriate modifiers for DME-related expenses, and it is beneficial to attach a copy of your physician’s prescription to your claim to avoid a denial. Listed below are examples of DME suppliers’ policies.

Before purchasing durable medical equipment, you must obtain a physician’s prescription. The government requires a prescription from a physician to obtain a durable medical equipment license. While some suppliers may not need a physician’s prescription, others may not. The supplier may be an individual or a business entity and must have a physician’s prescription. Make sure to insert the appropriate legal names on the forms.

It is ordered by a therapist

A therapist may order a DME for a patient, as a means of assisting them with activities of daily living. A DME may be prescribed to help with functional mobility and activities of daily living (ADLs). An evaluation by a multidisciplinary team, including physiatrists, occupational therapists, physical therapists, speech and language pathologists, and rehabilitation nurses, can determine if a patient requires a specific piece of equipment. A person may be eligible to receive DME for home use, allowing them to return to their home, community, or workplace.

It is delivered by a licensed supplier

In most cases, durable medical equipment (DME) is not a disposable item. It is intended for continued use and can include a hospital bed delivered to the patient’s home or a wheelchair. Other examples of DME include bath chairs, prosthetic limbs, and oxygen supplies. For these items to be covered under Medicare, the provider must have a regional carrier license. In some cases, the provider is a home health agency.

If you are looking to provide DME to a nursing home or hospital, you need to obtain a license for this business. A DME permit allows you to procure and distribute the needed DME to residents. This license does not grant you authority to procure prescription drugs, but it does give you the authority to sell and lease DME. The permit also allows you to sell and lease the DME to nursing homes.

You can search by Medicaid provider ID or name to find a licensed DME supplier in your area. Using this database will help you identify a provider that participates in Medicare and also search for the specific DME you need. If you don’t find a provider in your area, you can use Find Medical Equipment and Suppliers to find DME providers in your area.