What Is DME in Healthcare

Everybody loves a good acronym. ASAP. UFO. IOU. OMG. DIY. LOL. 

At Medbill, our favorite is DME. But what is a DME, exactly, and who qualifies as a DME provider? Are there unique restrictions or requirements for billing for DMEs? What’s the best way to bill for DMEs? 

What Is DME?

What qualifies as durable medical equipment (DME)? A DME must meet five criteria: 

  1. Must be able to withstand repeated use (in other words, be durable) 
  2. Must be used for medical purposes
  3. Isn’t useful without a medical reason 
  4. Must be used in the home 
  5. Can be expected to last for about 3 years of use 

According to the U.S. Centers for Medicare and Medicaid, items that qualify as durable medical equipment include (but are not limited to):

  • Blood sugar meters
  • Blood sugar test strips
  • Canes
  • Commode chairs
  • Continuous passive motion devices
  • CPAP devices
  • Crutches
  • Hospital beds
  • Home infusion services
  • Infusion pumps and supplies
  • Lancet devices and lancets
  • Nebulizers and nebulizer medications
  • Oxygen equipment and accessories
  • Patient lifts
  • Pressure-reducing support surfaces
  • Suction pumps
  • Traction equipment
  • Walkers
  • Wheelchairs and scooters

Billing for DME

The billing process for DME can get complicated and sometimes even confusing or surprising. Navigating the exhaustive (or, exhausting) regulations, restrictions, rules, and policies for paying and billing for DME isn’t for the faint of heart. 

Medicare, for example, pays for 80% of the costs for DME after the deductible is met. However, Medicare pays for different DME items in different ways. Patients may be required to purchase equipment, they may only be allowed to rent it, or they may have the option to rent or buy. But unless doctors and suppliers are enrolled in Medicare, the government won’t pay. 

Other healthcare providers and insurers may have different policies with regard to charging for DME, making the billing process even more complex. 

The amount that can be billed for DME varies widely, and depends on several factors:

  • Types of insurance the patient carries
  • Types of insurance the doctor or provider accepts
  • Charges by the doctor or healthcare facility
  • The type of facility where the patient gets their care
  • The location of where any testing takes place, where the DME is acquired, or where the service is provided

Of course, the most frustrating part of billing and collecting payments for DME is the dreaded rejected claim. And when that happens, it can take additional weeks or even months for DME suppliers to get paid.

Medbill and DME

The most effective and expedient way to bill and collect payments for DME is to depend on a medical billing expert to do it for you. Medbill is the country’s number-one medical billing company, employing a team of experts with in-depth knowledge of the constantly changing medical billing process.

With Medbill, you can get paid faster, save the tons of time it takes to manage bills and payments, avoid rejected claims, and save money. Find how much Medbill can save your DME business by contacting us for a quote. 

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