Is Medicare reimbursement for DME becoming much more difficult?

Specialties Home Health

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I spoke to a director of a skilled home heathcare agency who said it can take months to get Medicare to pay for needed DME (homecare beds, commodes) for her patients. She said there are at least two problems with the new Medicare rules.

First, the new Medicare rules require home care patients (who are often home-bound) to visit with a physician who must document their needs for DME, and write a Certificate of Medical Necessity. The agency must then go through the application process to obtain the equipment using the certificate. Clearly the difficulty of getting the patient to the doctor's office in the first place, and then getting the certificate and submitting the paperwork creates a roadblock.

On the supplier side, she said the new Medicare bidding requirements for who is allowed to supply the DME have resulted in large nationwide companies putting in low bids which crowd out local DME suppliers. These bids are so low that the supplier companies cannot make money on a variety of DME items and therefore try to avoid actually renting some types of equipment to patients. They drag their feet and slow or halt the process, and the patient has to wait and in some cases is denied the equipment for a variety of reasons.

Are these problems being experienced by other caregivers in homecare agencies?

It's brutal. Hospital beds are rare now, whereas in the past there was one in every home, even if collecting dust. (An exxageration but there was clearly abuse going on).

And low air loss mattresses? Forget it.

Our local DME, longstanding customer service oriented independent, has gone to rentals OOP in order to get the equipment out to the patient in a timely manner. They won't bother with much billing anymore, there's nothing worse for a local guy to have go pull needed equipment out of the home, and literally out from under the patient, due to a Medicare denial.

I miss is the old days when I just had to make a quick call to have equipment delivered same day (this in a rural often remote area) and the paperwork would follow. No abuse, just excellent care. No more, though.

There have been a few cases where I've refused to accept patients unless they go home with the proper equipment, it's sometimes the only negotiating power we have and being the only HH agency, it pushes insurance to auth the needed DME in order to discharge the patient.

The sad part is, every one of these tightening criteria is in response to years of fraud and abuse. On everyone's part. I have many times literally seen dusty equipment sit in the corner that families didn't return wanting to run out the monthly rental until it was purchased in full so they would have it just in case.

I have encountered this in the last few months. We have been receiving emails from the person in our office who handles DME requests with the updated medicare required documentation needed to process the order: nursing notes, inpatient stay notes, md notes, authorization and specific wording to justify need. Now that DME suppliers have to win the bid for each type of equiptment, there are less suppliers and for my patients in rural or suburban areas, delivery of item can be very delayed (like only delivering to that area once a month!!)

One time a patient was trying to get a new motorized scooter as hers broke and was actually a safety and fall hazard as an arm rest broke off and the foam was falling apart. It took over a year for it to be approved and by that time the patient was discharged from the agency. It's very frustrating.

The one item that they no longer cover at all, shower chairs/transfer benches, is the one that really gets me. How is the patient supposed to bathe safely in a shower/tub without a shower chair, especially if with chf, sob, copd or lower limb surgery? I understand a patient doesn't HAVE to take a shower, but why make them have to sink bath or bed bath if they have a perfectly working shower?!?!? I feel a shower has therapeutic qualities for my patients and makes them feel better.

Specializes in GENERAL.
It's brutal. Hospital beds are rare now, whereas in the past there was one in every home, even if collecting dust. (An exxageration but there was clearly abuse going on).

And low air loss mattresses? Forget it.

Our local DME, longstanding customer service oriented independent, has gone to rentals OOP in order to get the equipment out to the patient in a timely manner. They won't bother with much billing anymore, there's nothing worse for a local guy to have go pull needed equipment out of the home, and literally out from under the patient, due to a Medicare denial.

I miss is the old days when I just had to make a quick call to have equipment delivered same day (this in a rural often remote area) and the paperwork would follow. No abuse, just excellent care. No more, though.

There have been a few cases where I've refused to accept patients unless they go home with the proper equipment, it's sometimes the only negotiating power we have and being the only HH agency, it pushes insurance to auth the needed DME in order to discharge the patient.

The sad part is, every one of these tightening criteria is in response to years of fraud and abuse. On everyone's part. I have many times literally seen dusty equipment sit in the corner that families didn't return wanting to run out the monthly rental until it was purchased in full so they would have it just in case.

Yes Libby1987,

Here in South Florida it's a virtual honey pot for fraudsters.

All kinds, from DME to Moe, Larry and Curly schools of CNAery, and LPNery as well as the for-profit colleges that prey upon minority and atypical older students and those who remember post secondary colleges as not being total youtube instruction jip joints.

But to the point: why the problem with DME now?

Lax oversite coupled with expecting the honor system to be applicable to greedy scoundrels.

"Don't worry. The catheters are free to those that qualify and we'll take care of the Medicare billing to make it easy for you."

But DME businesses are an easy target. They are usually small and medium sized businesses that can't pay an army of lawyers to run interference against the Department of Justice.

The real Lex Luthors of deceit are your friendly hospital corporations such as the one formerly headed by present Florida govenor Rick Scott who as then CEO of Columbia/HCA paid a fine of over 2 billion dollars to settle at the time was the largest fraud settlement in U.S. history.

Good grief, I meant exaggeration.

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