Durable Medical Equipement and supplies prescriptions

[NurseNeLz]

Hi all. I've recently started a job as a field NP doing home visits. I feel pretty confident in my work but what has got me stumped is ordering medical supplies and what's covered. Does anyone know where I can get more info on this? I'm not sure what's covered and exactly how to order them. For example I had a patient where Texas catheters, foley drainage bag, wound care supplies were all needed and I wasn't quite sure how to write the RX.

[middleagednurse]

If you have access to the patients insurance info call the provider number on the card to find out what the insurance coverage is.You can get on AARPmedicareplans.com to look up DME providers by zip code.

[NurseNeLz]

Thanks!

[Alicia777, MSN, NP]

For DMEs I write;

1. Item name and quantity

2. Length of need

3. My NPI number

4. Sign it

That's it. Haven't been called so far 😉

[rnsrgr8t]

I am lucky that we have social workers that can help us find which DME company works with a patient's insurance. See if your patient already has a social worker that works with them. If you do not have access to that, then you can call the insurance company and find out which DME provider will work.

For the script I write similar to what @Alicia777 does

I also add the diagnosis with ICD-9 # and how many refills (they typically send a month's worth of supplies at a time)

Sometimes you have to wait for the DME company to submit it to the insurance to see what is covered. Once you get the knack of it and learn the most common insurance companies of your patients, you will have a better idea of what is covered and what is not.

Sometimes you do have to do a letter of medical necessity to PROVE why your patients may need something that is at a quantity that exceeds their norm or something that is not covered. You MAY be able to get it approved after that.

I have found that, although I am recognized as a provider by some of them, some insurance companies will not accept my signature for DME, they only want an MD. Also a lot of insurance companies want a copy of your most recent visit note that proves they need the supplies. Typically they need a new note every 6 months.