Challenges and Opportunities of Durable Medical Equipment Practice (DME)

The necessity of Durable Medical Equipments (DMEs) had never been so high – in U.S. 30% to 54% of those over 65 years have some form of disability; around 75% to 90% of such disabled require some form of DME to keep them mobile or enabled. It is also estimated that around 1.5 million people are currently in need of wheelchairs and braces. And, when you add the population that is likely to be in need of other forms of durable medical equipment – prosthetics, orthotics, and supplies (DMEPOS) – it will be some opportunity to people involved in Durable Medical Equipment services: physicians, pharmacies, and manufacturers/suppliers. But, because DME services are physician-recommended, we are more interested in how physicians themselves can recommend, source, and administer DMEs.

While physicians can benefit immensely from an integrated DME management, there are challenges on way – being equipped with a Medicare enrolled and recognized pharmacy, sourcing supplies from bidders authorized by CMS, and showing up as participating supplier, who accept Medicare approved fees on DMEs.

Physicians who are willing to have pharmacies attached with Medicare Part B approval need to have a full-pledged Medicare Part B recognized DME supplies. The importance of having Medicare approved DMEs at your pharmacy is that it enables patients to have access to DMEs that are fully covered and reimbursed from Medicare Part B.

DMEs cannot be freely traded at your pharmacy; you need to apply for authorization from CMS. First, you need to apply by filling up Form CMS-855S for all likely suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). Applications are verified by National Supplier Clearinghouse (NSC) before being certified for compliance with DMEPOS Supplier Standards, as set forth in 42 CFR 424.57

Physicians in DME services are expected to be responsible – being responsible means agreeing to accept Medicare-approved amount as full payment. Physicians that accept this clause will stand to collect only 20% of the approved amount after the patient has paid the part B deductible. Though not mandatory, being partner in sharing monetary responsibility may have disguised benefits, such as goodwill and patient-initiated referrals.

While suppliers recognized by CMS are generally dependable, there have also been cases of sub-standard supplies. Accepting any supplies without thorough inspection may prove to be clinically inapt or underperforming. Therefore, physicians from time to time need to verify suppliers’ credentials and report cards as and when they are published by CMS.

Notwithstanding these possible challenges ahead, physicians in DME services should have ample scope for revenue generation. Consider the scenario when Medicare will be extended to every U.S. citizen – with a majority of current Medicare beneficiaries yet to utilize DME benefits, DME practice itself will be a major attraction amongst practitioners. And, with strategic partnership with medical billing providers, physicians can expect to overcome these incumbent challenges, and become more than being just survivors.

Medicalbillersandcoders.com has always responded positively to every clinical and operational challenge. Whether it is billing and coding, EHR implementation, or ICD-10 transition, we have been the first to assume responsibility. Medical practices of varied sizes and disciplines across the 50 states in the U.S. would readily endorse us as most dynamic and comprehensive source for overcoming clinical and operational challenges. And, at a time when DME practitioners find themselves in between opportunities and challenges, we are hopeful of helping them overcome challenges and realize opportunities.