Does Medicare Cover DME in a Long Term Care Facility?

While there are multiple parts to Medicare insurance coverage, this article will focus on Medicare Part B coverage. Part B determines if your insurance covers durable medical equipment (DME).

Regarding the question, “Does Medicare cover DME in a long term care facility?” Part B will provide DME, but certain insurance conditions must be met. This article will provide details on understanding Medicare coverage and how it covers DME equipment.

Does Medicare Cover DME in a Long Term Care Facility?

Medicare Part B covers medical equipment and supplies, aka DME, prescribed by a doctor or health care professional. It’s important to note that Part B covers equipment and supplies for use in your home.

What qualifies as my “home”?

A hospital and skilled nursing facility do not qualify as a “home.” If care is received in a long-term care facility that doesn’t provide primarily skilled care or rehabilitation, it does count as a “home.”

Medicare Part B Coverage

Medicare Part B will cover DME in a long term facility, as long as a doctor or healthcare provider prescribes the equipment. Then the DME equipment is dispensed from a DME supplier currently enrolled in Medicare.

What does Part B cover?

Medicare Part B covers:

  •   Certain doctor visits
  •   Medical equipment
  •   Medical supplies
  •   Outpatient care
  •   Preventive services
  •   Tests

Working with a Medicare DME Supplier

It’s important to note that Medicare will only cover DME if a supplier is approved by Medicare and has a Medicare supplier number.

If you’re unsure if a supplier is Medicare-approved, ask the supplier the following questions.

  •   Are you a Medicare-enrolled supplier?
  •   Do you accept Medicare assignments?
  •   Will you bill Medicare for me?

Even if an item is bought from a department store or large chain, Medicare will not pay the claim if the supplier is not approved[KK1] .

What to Know About DME and Medicare

Medicare has strict guidelines for DME equipment. Make sure you understand the requirements and reach out to the Centers for Medicare and Medicaid Services (CMS) with any questions.

What is DME Equipment?

DME includes medical equipment that:

  •   Can be used in your home
  •   Can be used repeatedly 
  •   Is durable and will last for 3+ years

Equipment Examples

DME that help with daily needs is covered by Medicare Part B. Equipment includes:

  •   Artificial legs, arms, etc.
  •   CPAP devices and accessories
  •   Crutches
  •   Hospital beds
  •   Orthotics like neck braces, rigid or semi-rigid arms, legs, etc.
  •   Portable oxygen equipment
  •   Prosthetic devices that replace an internal organ
  •   Some medical supplies
  •   Wheelchairs
  •   Walkers

Need something not listed? Contact CMS with any questions.

Medicare Part B Does Covers DME in a Long Term Care Facility

If you are receiving aid in a long-term care facility that doesn’t provide primarily skilled care or rehabilitation, it does count as your “home.” Make sure a doctor or health care provider prescribes the DME equipment. Then make sure it’s ordered from a Medicare-approved DME supplier. If you have any questions, it’s best to reach out to CMS for answers. 

Medbill Can Help

As a full-service, 100% U.S.-based, DME billing company, Medbill helps DME providers with their needs. The Medbill team can help providers become audit ready by assisting them with document review, claims submission, daily billing activities, and more. 

Contact us the Medbill team today to learn more.

Reference:

Medicare Coverage of DME & Other Devices Government Booklet