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hi everybody Jennifer blevin Smith with integral Clinic Solutions and you're watching my YouTube channel navigating the business of Medicine [Music] today I want to talk about DME billing that is durable medical equipment d as in delta M as in Mike e as in Echo a lot of people in different Specialties bill for DME it is stuff that is considered reusable it's medically necessary it's going to be used in the patient's home it's going to last a while like it's going to be needed to be reused for a while there are some other criteria that qualifies things as DME but a lot of people don't realize that in order to build Medicare for DM you have to have a separate p-tan number so you get a pitan when you become or a when you become contracted with Medicare they send you a letter with a P10 number for your group and then you get one for your providers well in order to bill for demi posts which is what Medicare calls DME because it's durable medical equipment Prosthetics Orthotics and supplies so DME p o s so we call it Demi post or DME and you have to provide a separate p-tan in order to enroll and submit claims to Medicare to Bill these supplies so they go to a whole different place at Medicare the claims gets split so if you put them on your claim for services rendered such as your e m and any kind of labs or whatever you also you have to send a separate claim with just your DME stuff to a separate place of Medicare and I'm sure your Billing System will help you get that all situated but you have to have a separate p-tan to enroll in that claim submission you can't use your Medicare dis straight P10 number and this can be really confusing to people but the straight Medicare Part B as in boy won't cover DME it has to be separate that's same for commercial insurances they will cover DME but you have to make sure that you're using the correct codes you have to make sure that you're using the right diagnosis codes and you also need to make sure that you're supporting the medical necessity depending on the guidelines for coverage for certain equipment it might be something that they have to rent that they can't buy it might be something that they have to buy or it might be something that they get to choose whether they buy it or they rent it again this includes crutches wheelchairs diabetic sugar testing monitors and let's see here splints any kind of slings those types of things so if you're an urgent care you're a pain management your primary care depending on what you see diabetic Specialists neurologist I mean there's so many Specialties that bill out DME and it is just a little bit different it has a little bit of its own um requirements it has its own codes it has those types of situations and for your specialty you need to be aware of what insurances will and will not cover when it comes to DME for patients because it might be cheaper or more affordable or better for you and the patient that they just pay cash for this like Orthotics maybe like custom-made Orthotics or maybe you need to give that patient a heads up of how much it's going to cost and of course it gets applied to deductibles right so if they haven't met their deductible then they have to pay for it out of pocket and then if they have met their deductible then they only pay their co-insurance so I mean it's not just because it's ordered by a doctor that it's a should be assumed that it's going to be covered at a hundred percent so that also puts things in a little bit of a different situation because I think patients have this misunderstanding that if the doctor orders these supplies then it will be covered as opposed if they were to go to the store and buy a sling or a splint out of pocket and it's just you know different ways to get there now remember if you're billing Medicare chances are if Medicare does cover it you can't bill the patient or have them pay cash unless you get an ABN form up front and that's a whole nother story a whole nother video that we would need to go over but just be aware that you need to check your contracts with your payers about DME about billing hopefully you have someone in your practice who is very well versed in billing and coding for DME because that is only a benefit to you because this stuff is expensive if you have to have some of this stuff in your office to provide to patients when they're seen that's money out of your pocket up front with it hopes that it will be reimbursed down the road and then of course there's other things that you put in orders and you know a Home Health Supply will bring it to the patient or something like that but like crutches and splints and slings and stuff that you need to provide to patients immediately in order for patients to feel comfortable or out of pain or stable or whatever you need to have that in your office so you really want to make sure that you understand the billing for that so you don't lose any money if you have any questions or comments about DME I'm not gonna lie I am not that strong at billing for DME I just know the very high level overview that I'm providing to you today but maybe someone else who is reading this or watching this would be able to provide some more feedback for you so please don't hesitate to leave that in the comments below smash that Thumbs Up Button if today's video was helpful because it does help with that YouTube algorithm and I see my Channel Growing and it's just so exciting to me so please help me out on that smash that Thumbs Up Button of course subscribe to my channel if you haven't already and we will see you next time take care of yourself thank you so much again bye-bye [Music]