Dme

[Pain Applicant1]

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Can anyone give me some tips on how to obtain my DME license. Is it worth the effort to get it? Are TENS units reimbursed?

 

[inspire004]

I was told they are well paid. Tell me if you are got my PM about overheads.

 

[lobelsteve]

It used to be well worth it. Now it is not as rewarding.

Go to CMS website and download the 855s application.

https://www.cms.gov/cmsforms/cmsforms/ItemDetail.asp?ItemID=CMS019480

Have fun.

I use Empi, RSMedical, DJ, and local P&O guys for AFO's.

 

[Pain Applicant1]

It used to be well worth it. Now it is not as rewarding.

Go to CMS website and download the 855s application.

https://www.cms.gov/cmsforms/cmsforms/ItemDetail.asp?ItemID=CMS019480

Have fun.

I use Empi, RSMedical, DJ, and local P&O guys for AFO's.

Thanks a lot. I appreciate the help.

 

[emd123]

:bump:

Anyone doing back braces as DME? It seems logical to give a patient the occasional back brace for vert compression fracture or severe back pain with movement from spondy.

A rep came in the other day and encouraged me to get my DME license. I know the abuses of DME sales has made it harder to supply, but I think for the occasional patient who wants a brace or might have pain relief from one, I might as well supply it rather than send them out for it. I would never do this for any or all patients, like some have.

Anyone doing back braces/DME out of their office?

 

[NJPAIN]

:bump:

Anyone doing back braces as DME? It seems logical to give a patient the occasional back brace for vert compression fracture or severe back pain with movement from spondy.

A rep came in the other day and encouraged me to get my DME license. I know the abuses of DME sales has made it harder to supply, but I think for the occasional patient who wants a brace or might have pain relief from one, I might as well supply it rather than send them out for it. I would never do this for any or all patients, like some have.

Anyone doing back braces/DME out of their office?

Yes. So far it is reimbursing well.
Regarding the Dme license, it is a pain in the butt. They scrutinize every detail and will reject it repeatedly if all is not just as they like it. I paid a young man who has done the application for many people in the past. His Dad is an MD and he does the billing. He knows all of the ins and outs. Made it painless. Not cheap but worth the money. If you want to PM me I will give you contact info,

 

[Pain Applicant1]

I vote for doing it yourself. Just following the instructions on the form. If you have questions, call the help number.

Be cautious when dispensing DME, you could violate Stark law. $100,000 fine per violation and loss of being reimbursed by Medicare forever. Regardless of what the DME companies say (they want you to buy their products), it's important to understand the Stark law.

 

[inspire004]

If I get a dme license and prescribe a back brace and get paid is that a stark violation.

 

[emd123]

If I get a dme license and prescribe a back brace and get paid is that a stark violation.

Maybe, maybe not. The more I read, the more confused I get. Did CMS close the loophole on this making it a Stark violation? It kinda looks like it. For CMS patient only? Private insurers, too? I don't know.

I found these:

http://www.kr-law.com/current.php?id=104

http://www.foxrothschild.com/newspubs/newspubsArticle.aspx?id=4294971872

 

[michaelrack]

You don't want to mess with DME for medicare patients. Check with your major private insurers and see what it takes to be in network with them for DME (or if they even have a network status for DME).

 

[emd123]

Are back braces even DME?

Someone was just telling me that back braces are considered off-the-shelf orthotics (not DME) by CMS and can be distributed by a doctor's office.

 

[Pain Applicant1]

Are back braces even DME?

Someone was just telling me that back braces are considered off-the-shelf orthotics (not DME) by CMS and can be distributed by a doctor's office.

Just be careful if that person works for a DME company selling you the back brace or if that information came from someone like this.

 

[Zeffer]

If you're unsure whether or not you're violating a stark law I would recommend you contact an attorney who specializes in stark laws. If you're violating stark laws and Medicare or Medicaid discovers your violation(s) you will receive a $15,000 per (Medicare/Medicaid) occurrence fine.

 

[Pacman27]

Are there CMS standards / LCD's as to when we can provide a patient a back brace or other braces?

 

[Pain Applicant1]

Are there CMS standards / LCD's as to when we can provide a patient a back brace or other braces?

Yes. Just google the HCPCS code and LCD, etc. Of course things are never that simple and you have to make sure you're not violating any laws, etc. That's the tricky part regardless of how simple the DME companies at the conferences make it out to be.

 

[emd123]

Medical necessity for off the shelf orthotics (back braces) isn't linked to ICD 9 codes like our procedures are.

This is what they require:

"Medically Necessary: The use of prefabricated thoracic-lumbar-sacral orthoses (TLSO), lumbar-sacral orthoses (LSO) and lumbar orthoses with custom fitting is considered medically necessary when any of the following conditions are met: 1-To reduce pain by restricting mobility of the trunk; or 2-To facilitate healing following an injury to the spine or related soft tissues; or 3-To facilitate healing following a surgical procedure on the spine or related soft tissue; or 4-To otherwise support weak spinal muscles or a deformed spine"

That's what Medicare requires. That's it. Practically any of our common back pain diagnoses potentially apply, by causing pain from "trunk motion."

 

[Pacman27]

Few questions

1. Can anyone provide guidelines or standards by CMS to provide bracing, not sure if they have specifics for each type or if any even exists?

2. Can someone share their proof of delivery forms and complaint protocol policy that they utilize or where I maybe able to find a sample?

3. Also does anyone provide TENS units?

Thanks in advance

 

[emd123]

Double post

 

[emd123]

Few questions

1. Can anyone provide guidelines or standards by CMS to provide bracing, not sure if they have specifics for each type or if any even exists?

2. Can someone share their proof of delivery forms and complaint protocol policy that they utilize or where I maybe able to find a sample?

3. Also does anyone provide TENS units?

Thanks in advance

Dude....it's practically all in this thread already.

Also, this should not be construed as legal advice. I repeat, I do not give legal advice and you must contact an attorney for that.

1-To answer your first question, you literally need to look at my post, directly above yours. That's straight from the Medicaire guidelines. Those are the only 4 requirements (only need 1). Verify this yourself and with an attorney.

2-Then read this (also from another one of my posts above) which has some some important info:

http://www.foxrothschild.com/newspubs/newspubsArticle.aspx?id=4294971872

3- Then apply for your DME license (look at Lobel's post, 3rd in thread). Will take at least 6 months to get.

4-Then have an attorney experienced in Stark and healthcare, review your plan, draw up consents/paperwork/forms and advise you on how to proceed within all the legal guidelines and requirements.

5-I wouldn't do TENS, neck braces, extremity splints, etc. I think that's pushing it.

It will take a year to get all this done properly, but it's a highly scrutinized area and you want it done 100% right, just like your taxes and other billing, because audits are common.

 

[Pacman27]

Thanks... Just noticed the above, but still got a lot of other info as well... 🙂