DME

For an unannounced Durable Medical Equipment (DME) site visit, you'll need to have readily available documentation demonstrating compliance with DMEPOS supplier standards, including licensure, insurance, inventory, complaint resolution protocols, and instructions for beneficiary use. The inspector will verify this information and may also take photographs of the facility. This should not be a surprise. When you applied for your DME ID number, you filled out the Medicare enrollment application, form CMS-855S, and when you signed the application, you agreed to follow the rules. Here are the rules for what needs to be present when an unannounced DME on site visit occurs.

“I read the Medicare DME requirements for diabetic shoes and inserts. I am still confused and am seeking clarity. I know for diabetic shoes, it requires a MD/DO to certify that patient has diabetes with neuropathy and thus, qualifies for diabetic shoes and 3 custom insoles. It is my understanding that Medicare only covers orthotics if the patient is diabetic and as stated above, is certified to have diabetes with neuropathy. I have seen other physicians use the KX modifier to get orthotics incorrectly paid. My question is: If I just want to dispense the custom molded diabetic insoles (three pairs of orthotics/diabetic insoles as allowed by Medicare — and not the shoes), are there separate rules or are they the same rules? Is it legal to do a cash pay for diabetic/soft custom insoles? Any other tips you have found useful in your practice? Have you in your practice just dispensed the insoles and not the shoes?”

Recently there was a report in a publication received mostly by Orthotic and Prosthetic (O&P) providers (mostly orthotists, prosthetists and pedorthists) that created quite a stir for several podiatrists They thought based on this story, that the sky was falling and that DPM's were no longer going to be able to provide certain DME services in 17 states where licensure requirements are in existence.

An opinion on when you need Business Associate Agreements when working with Durable Medical Equipment Vendors.