DURABLE MEDICAL EQUIPMENT (DME)
An item that can be used for an extended period of time without significant deterioration. Therefore an item that can be rented and returned for re-use would meet the requirement for durability.
Medical supplies of a disposable nature such as incontinence pads and surgical stockings
would NOT qualify as durable.
Medically oriented equipment
Generally not useful in the absence of an illness or injury. For example, an air conditioner may be used in the case of a heart to lower room temperature and reduce fluid loss.
Most plans allow for the purchase or temporary rental of equipment and supplies
when prescribed by a physician
Evaluating reasonable and necessary
an item may meet the definition of DME and not be covered by the plan.
Two things to be considered are
1. Reasonableness-Evalulates the soundness and practicality of the DME approach.
2.Necessity- Equipment is necessary when it is expected to make a meaningful contribution to the treatment of the patient's illness or injury or the the improvment of the functioning of a malformed body part.
Even with a physician's prescription
it may be necessary to refer teh claim to a consultant for review prior to payment or approval for purchase.
All claims for DME should be documented with the following information:
1. A description of the equipment prescribed by the physician.
2. A statement of the medical necessity of the equipment.
3. An indication as to whether the item is to be rented or purchased and the rental or purchase price.
4. The estimated length of time that the equipment will be needed.
5. An indication as to where the equipment will be used and for how long.
Repairs are covered
when necessary to make the equipment functional.
Replacements are usually covered
in cases of irreparable damage or wear or when the patient's physical condition has changed.
Charges for delivery of the DME and oxygen
are usually covered.
Designed to replace a missing body part or to restore some function to a paralyzed body part.
Prosthetic devices include
the making and application of an artificial part medically necessary to replace a lost or impaired body part or function, such as an artificial arm or leg, obturator, or urinary collection and retention systems.
Covered expenses associated with prosthetics include:
*Shipping and handling as part of the purchase price.
*Temporary postoperative prostheses.
*Replacement charges when replacement is due to a change in the patient's physical condition.
**Replacement is NOT covered for wear and tear.
Medical and Surgical Supplies include:
1. Disposable, nondurable supplies and accessories required to operate medical equipment or prosthetic devices.
2. Necessary drugs and bioligical items put directly into equipment(such as nonprescription nutrients)
3. Initial and replacement accessories essential for operating medical equipment.
4.Supplies furnished and charged by a hospital, surgical center, or physician as part of active thereapy, such as ace bandage, cast or cervical collar.
Do not include items or supplies that could be used
by the patient or a member of the patient's family for purposes other than medical care.
Questionable items should be referred to your supervisor or other designated person with the following information:
* Patient's diagnosis
* prescription from attending physician.
* Product description, literature, and prices.