Can DME/HME Be a Profitable Venture For Your Practice?

Even two years ago the answer to that question might have been “no”. However, in 2007 it might well worth looking into for your practice. Previously, the cost of the products versus having to track claims, find reimbursements, and keep up with claims status; made DME a very labor intensive venture. With the advent of specialized DME/HME software, secure internet connections, and standardized billing procedures; DME can now be a very profitable venture.

In your practice, you will want to be sure that the product(s) you are dispensing are profitable. You need to watch the pricing of the product costs, in some instances, your product costs may be more than the carrier is willing to reimburse you for. When handling for Medicare patients, the process is much easier. The prices for DME supplies are easy to look up in the DMERC’s supplier manual. For other carriers, always call and don’t assume they use Medicare pricing.

For many claims you will need to obtain pre-certification to insure reimbursement. Pre-certification is not a hard process, but it can be tedious. You can be rejected if your DME forms are not filled out absolutely accurately and completely. Medical billing firms who handle DME claims are very valuable in this respect, because the busier your practice is, the less time you have for filling out and following up on DME and other medical billing forms.

Fortunately for Medicare patients, very few items require pre-certification before billing as a DME claim. Formal Certificates of Medical Necessity (CMN’s) are required for certain items like wheelchairs, but are generally not required for items such as therapeutic shoes, surgical dressings or walkers.

In summation, watch your product cost, get a good medical billing firm to handle your claims and always have good documentation and you should find DME/HME will become a nice revenue generator for your practice.

View all Articles by: Melissa Clark, CCS-P