DMEPOS Meaning and Its Special Payment Rules

If you’re new to the industry or just looking for a refresher, you’re in the right place. Durable Medical Equipment (DME) and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) is a heavily regulated industry with strict payment rules that change frequently. The Centers for Medicare and Medicaid Services (CMS) set the industry standards for suppliers to receive claim payments. 

So, if you want to learn more about DMEPOS’s meaning and the payment rules, continue reading. Then if you want to learn how the Medbill team can increase your collection rate (and your revenue), read to the end! 

A Deeper Looking into the DMEPOS Meaning

DME is medical equipment that patients repeatedly use in their homes, and DMEPOS also includes prosthetics, orthotics, and other in-home medical supplies. Some examples of DMEPOS items include:

  • Arm, leg, back, and neck braces (orthotics)
  • Artificial limbs (including article eye implements) 
  • Blood glucose monitors or meters
  • Continuous positive airway pressure (CPAP) devices
  • Hospital beds
  • Infusion pumps
  • Negative Pressure Wound Therapy (NPWT)
  • Ostomy bags 
  • Oxygen equipment
  • Urological supplies
  • Ventilators

Review CMS’s master list of all DMEPOS items here.

Who Can Sell DMEPOS?

According to CMS, only accredited DMEPOS suppliers can sell this type of equipment and file a claim for reimbursement from Medicare patients. This type of supplier is a business that sells or rents DMEPOS items to Medicare beneficiaries covered under Medicare Part B. In order to become an accredited business, suppliers need accreditation from a CMS-approved independent organization. Learn more about becoming a DMEPOS supplier.

DMEPOS Special Payment Rules

Now that you understand more about the DMEPOS meaning, next is learning about its payment rules. Following these rules are necessary to be reimbursed for the equipment you sell or rent. In 2003, the CMS developed the DMEPOS Quality Standards to ensure all suppliers receive proper accreditation to receive Medicare billing privileges. All suppliers must comply with the current standards to maintain their billing rights.

An Overview of the DMEPOS Quality Standard Rules

CMS’ Quality Standards are a lengthy and comprehensive list of rules, which is why hiring or outsourcing DME billing coordinators is necessary. To simplify the learning process in this article, there are two sections and three appendices. Each area focuses on specific business and service requirements.

Section 1

This section explains the requirements regarding your business services and management responsibilities. 

  • Administration
  • Consumer services
  • Financial management
  • HR management
  • Information management
  • Performance management
  • Product Safety

Section 2

The following section discusses the product-specific requirements.

  • Delivery and set-up
  • Follow-ups 
  • Intake and assessment
  • Patient/caregiver training with instructions 

Appendix A

Explains the requirements for respiratory equipment, supplies, and services.

Appendix B

Explains the requirements for manual and complex rehabilitative with assistive technology wheelchairs and Power Mobility Devices (PMDs).

Appendix C

Explains the requirements for custom fabricated and fitted orthoses, prosthetic devices, therapeutic shoes with inserts, and customized somatic, ocular, and facial prostheses. 

Read The Quality Standards in Depth 

Read CMS’s latest Quality Standards rules for DMEPOS items furnished and DMEPOS supplier billing privileges here.

5 Reasons Medbill Should Be Your #1 Billing Choice

We’re a full-service DME billing company that’s here to help you succeed. Read the five reasons we’re the top choice for DME suppliers. 

#1 Results-Focused Services That Show How We Impact Your Business 

#2 Provide Guidance and Assistance on Navigating Industry Changes

#3 Equip Your Staff with Ongoing Education, Repurposing Plans, & Feedback

#4 Strengthen Your Financial Stability 

#5 Gain Insight into Your Billing Practices with Our Free Benchmark & ROI Review

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