DME Procurement: Why It’s Important For Our Partners

By Colin Hunsberger, PT, DPT, GCS, CEEAA

Senior Regional Director

Ordering the most clinically-appropriate type of durable medical equipment can be intimidating.

You know your resident needs a wheelchair, but what exact model?

Should I order a K4 model, a K3, a K1, a reclining chair, a tilt-in-space?

Wait.

There’s a multitude of accessories and cushions I now need to choose from as well?

What’s the difference between a footrest and a leg rest?

Should I get the full-length swing back armrest or the adjustable, desk-length armrest?

A Jay cushion? ROHO?

Is a gel cushion better than a foam cushion?

Ordering the most medically-necessary DME is a daunting task for any senior living staff member. The good news, though: there’s a partner who’s uniquely qualified to assess, evaluate, and order this equipment: FOX Rehabilitation physical and occupational therapists! Your PT and OT are experts in both the functional health of your residents as well as utilizing properly-dosed activity and exercise, but also in skillfully deciding on the DME that will best support and improve your residents’ functional ability.

Now, utilizing your FOX PT and OT DME experts is only half the battle, the other half is getting the DME ordered and covered by Medicare.

What is Competitive Bidding?

As per Medicare, “Medicare’s DME, Prosthetics, Orthotics, and Supplies competitive bidding program changes the amount Medicare pays for certain DME items. Under this program, suppliers submit bids to provide certain medical equipment and supplies to people with Medicare.

Medicare uses these bids to set the amount it pays for each item.

All suppliers are thoroughly screened to make sure they meet Medicare requirements, such as eligibility and financial, quality, and accreditation standards) before they’re awarded contracts.

Competitive bidding was mandated by Congress through the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. Medicare’s competitive bidding program is projected to save nearly $26 billion on DME over a 10-year span.

That’s good for Medicare. That’s not so good for small business DME vendors who did not win the Medicare contracts from the competitive bid.

Bidding was awarded to a limited amount of vendors, and documentation to obtain DME has become burdensome. Therefore, clinicians ordering DME need to be knowledgeable in the ability to not only assess your resident for the most appropriate DME but also translate that into documentation painting an accurate portrait of medical necessity to Medicare for your resident to be approved for that DME.

Documentation that qualifies your resident for that needed DME

It can be difficult to capture all the needed documentation of written prescriptions and chart notes to satisfy the Medicare criteria to approve the DME order. This is another reason your FOX PT and OT DME experts are needed to assist. They will work with the prescribing physician and supply compliant chart notes that support the medical need of the DME,

How do we best decrease turn-around time for your resident to obtain this needed DME?

The old way of submitting orders for DME was slow, inefficient, and confusing. Each DME supplier had its own paper form, its own set of documentation, and its own fax line.

The new and improved way is to partner with a DME ordering software company who instantly checks for insurance qualification, routes all info to the physician, then to the correct DME provider. Additionally, most delays in turn-around time for your resident to obtain that DME is due to the therapist and physician not providing the Medicare-compliant documentation.

FOX’s partnership with a DME-ordering software company fixes this. FOX works in conjunction with this partner, the ordering clinician, the physician, and the DME provider. It creates a medically-compliant order inclusive of the clinician and physician’s chart notes.

When this type of system improves efficiency in connecting clinicians, physicians, DME providers, and the payer source of Medicare, your resident is the ultimate winner by receiving their needed DME.

The FOX patients in this photo are not referenced in this article.