Physician practices’ reimbursements are shrinking from all insurance companies, especially Medicare. Patient loads are smaller and operating costs are skyrocketing due to the present economy. Every medical practice should be looking at additional revenue opportunities with its own patient base while maximizing patient clinical outcomes.
One of those possible revenue streams might involve durable medical equipment (DME).
Overcome Your Fears
Practitioners often believe that it’s illegal to bill Medicare patients for DME and that it’s not profitable to deal with DME themselves; so for years they have been referring the business to orthotic and prosthetic (O&P) shops, manufacturers or third parties. Also, senior patients, who are often the recipients of DME, require a high standard of care to prevent unnecessary complications.
Medicare is one of the best payers in the country for DME – do you know how to get involved in this area? To do so, you need to understand how to obtain a Medicare DME license to bill the federal government, and how to comply with key legal guidelines like the Stark Law and the federal Anti-Kickback Statute. In short, you must become a DME supplier and fit under specific CMS rules regarding the in-office ancillary services exception.
Mind the Stark Law
The Stark Law (42 U.S.C. §1395nn) prohibits the referral of Medicare and Medicaid beneficiaries for certain designated health services (DHS), including DME and orthotics, to an entity with which the referring physician has a financial relationship, unless an exception applies. CMS has published a range of regulations relating to Stark and the issue of physician self-referrals.
It is important to note that only the following types of DME can be provided pursuant to the Stark in-office ancillary services exception: canes crutches, walkers, folding manual wheelchairs and blood glucose monitors.
There are three important things that you need to keep in mind concerning the provision of DME as a DHS under Stark:
- Location: DHS must be provided in the same building as a group practice physician office or another building used by the group practice in space that is occupied by the group on a full-time basis.
- Provider: DHS must be furnished personally by the referring physician, by another physician in the group practice, or by individuals supervised by a physician in the group.
- Billing: DHS must be billed by the group practice, or a billing agent may be engaged to bill DHS under the group’s name.
Compliance Leads to…Profitability!
Benefits of adding DME include maximizing clinical outcomes and keeping your patients happier with the added convenience, and lowering healthcare costs by limiting additional injuries and complications that could result in expensive surgical intervention. A DME program can also help your practice bring in new revenue – as long as you stay compliant! A revenue stream of $5,000 to $25,000 profit per month per doctor is possible with a compliant DME program.
How to Get Started with DME
In addition to considering accreditation and obtaining a Provider Transaction Access Number (PTAN), there is a DME compliance protocol that providers must follow in order to stay compliant. Full disclosure of patients’ rights and responsibilities is required, as well as forms involving a delivery ticket and patient agreement, and a product failure form. You also need a complaint resolution protocol, as well as a complaint log.
Practices that meet the following criteria have the best chance of developing a successful DME program:
- Your specialty involves treating knees and backs
- You have a good payer mix of Medicare, PPOs, workers comp and personal injury payments
- The size of your practice meets certain parameters regarding number of new patients per month, and number of existing patients
Attend “How to Bill Medicare for Durable Medical Equipment and Stay Legally Compliant,” an audio conference sponsored by ProfEdOnDemand and presented by healthcare industry veteran Gregory J. Simms, to find out what those parameters are, as well as how to set up the appropriate protocols. Gregory provides strategies for practices to start providing DME while achieving increased revenue and better service and outcomes for patients, covering all the details of how to bill Medicare for DME, increase your reimbursement and stay compliant.
