DME Pre-approval

DME Preapproval

Durable Medical Equipment refers to wheel chairs, braces, shower chairs and other assisted living equipment are generally are purchased as an outpatient.

It really does not matter if your patients are insured through Medicare, Medicaid, Workers’ Compensation or through a private insurance carrier, nearly all DME claims must be preapproved prior to submission of the medical billing claims.

Many of these policies have strict guidelines that must be followed in order for the DME medical billing claim to be paid. Some providers will require that the DME be purchased through their own sources and have a listing of specified providers. Many HMOs are very narrow about the DME they will reimburse a medical billing claim for.

Documentation and preapproval is the key and when you think you have enough, go for one more item to make sure you have a strong case. DME is one of the strictest and most watched aspects of medical billing due to the amount of fraud that has been committed by unscrupulous people.

Some guidelines for handing your DME medical billing claims include:

Make sure you have the required letters of medical necessity/physician prescription on hand to prove a legitimate need.

If preapproval or precertification is required for equipment, services or procedures, make certain to have that documentation on file.

There may be exclusion of certain equipment or other benefits associated with the DME, such as the patient may qualify for a wheelchair but not a specialized wheel for the chair to accommodate an aspect of the patient’s home.

There are normally yearly or lifetime dollar limits on DME claims paid.

Medicare sets the standard for many carriers as to what they will and will not pay for in a DME claim. A good example is Medicare will not pay for bathroom equipment such as commode chairs that might be needed by an MS patient. Many private carriers use the guidelines of Medicare and consequently, will also exclude such equipment from reimbursement.

This is where preapprovals and documentation are the strong suit of getting these DME claims paid.

View all Articles by: Melissa Clark, CCS-P