Forum - Questions & Answers
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.
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.
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.