Forum - Questions & Answers

Apr 1st, 2011 - BETH1031

DME Products

Does the Doctor have to be a licensed DME provider to be able to bill for a DME product? EX: patient comes in with a sprined elbow, she says that they need a sling, orders one from the hospital and gives to the patient. I beleive that the Dr. must have a DME license to be able to bill insurance or the patient, just wanted to make sure.

Apr 3rd, 2011 -

re: DME Products

I don't think so, at least for non-Medicare. But in your example, I am assuming the doctor pays the hospital for the brace and then bills the insurer. If he is getting it free, you should not be billing. And watch cost v. reimbursement- insurers often low ball prices to get docs to stop dispensing this kind of thing and instead directing pts to the pharmacy. Medicare is different- perhaps others know.

Apr 3rd, 2011 - mm2394 18 

re: DME Products

In order to be reimbursed for a DME item, the provider/supplier of the item must be enrolled with the DMERC as a provider/supplier. If the item is furnished by someone who is not enrolled with the DMERC, Medicare will not pay.



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