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Durable Medical Equipment | Proficient Rx

What is Durable Medical Equipment?

Durable medical equipment includes items that are used during treatment and recovery of an injury, illness or due to age related problems. They are typically non-disposable. They are often used both at home and at any location outside of the medical facility.

Equipment can be used by caregivers, family members or the patient themselves.

The equipment must be reusable and mostly for use in the home of the patient, or a long-term recovery unit of a medical institution. With in-home care services on the rise, so are the use of medical equipment needs within the home.

The durable medical equipment industry reached close to 42 billion dollars just last year, with numbers increasing.

Equipment is not the same as supplies.

 

Durable Medical Equipment vs. Supplies

Durable medical equipment is sometimes confused with disposable medical supplies. While both are needed and used by the elderly, ill and disabled, they are different.

The main difference is that durable medical supplies are items that help a patient care for themselves, but are disposed of once used. Examples of supplies include blood sugar testing strips for diabetics. Durable medical supplies can also include disposable gloves that a patient or caregiver may wear during a daily treatment.

Supplies can also include bandages, catheter equipment, needles for injections and diapers. If it is used once and then thrown away, it is considered a durable medical supply.

Durable medical equipment is prescribed for long-term use to help those in recovery from an illness or injury. In the case of the elderly, the durable medical equipment may be prescribed for an infinite amount of time.

 

Categories of DME

There are many categories of durable medical equipment. Mobility aids, personal care aids, prosthesis, orthotics and oxygen equipment.

Mobility aids are prescribed to patients who have a challenging time walking or who can’t get around well on their own. They are used to assist the patient in getting around physically. Personal care aids can include items that assist a disabled, ill or elderly patient complete their daily hygiene routines.

Personal care aids can help a person get in and out of a bath or shower, use the toilet and for added security from falling. They can even include products made to help patients dress themselves.

Prosthetic limbs enable patients to perform duties that require the limb the patient lost. Orthotics include footwear to correct a problem or to assist a patient in walking and receiving foot therapy at the same time.

Oxygen equipment can aid patients who struggle with respiratory problems. Example diagnoses include COPD and asthma.

 

Specific Examples of DME

Hospital beds are a very common piece of durable medical equipment. They can be ordered on a temporary or long-term basis, depending on the needs of your patient. Hospital beds are prescribed for patients who need to remain in a certain position that normal beds do now allow.

Hospital beds also allow attachments needed for patient health or recovery that cannot be attached to normal beds.

To help patients move around, a doctor can prescribe specific mobility devices such as wheelchairs, walkers, scooters and canes.

Specific personal care aids include rods to help patients pull up their own pants and socks. They can also include raised toilet seats for patients who have trouble bending. Bath and shower aids can include handles and shower stools.

All personal care aids enable the patient to remain independent.

Artificial limbs are serving over two million Americans today.

Orthotic equipment is often prescribed by doctors for foot therapy and pain relief. Common orthotics include shoe inserts, possibly to help with arch support. Others include heat moldable orthotics, and shoe insoles.

If not treated properly, orthotic ailments can lead to hip and back problems down the road.

 

Who Orders DME?

There are times when a patient will give themselves a diagnosis. Maybe they fell and are struggling to walk without pain. They may buy themselves a cane. Or, they are afraid of slipping in the shower, so they buy themselves a shower chair.

Many patients purchase durable medical equipment for themselves rather than getting a physician’s prescription. These are the patients who do not mind paying the full cost of the equipment.

Those who do not want to pay, or cannot pay, for equipment will need a physician’s prescription so insurance will cover the costs.

A face to face encounter with a patient is required in order for you to prescribe durable medical equipment. Once you determine your patient needs the device, you put in an order. Most doctors file claims for the patients whose insurance requires it.

Durable medical equipment is paid by an insurance company most of the time.

 

Who Pays for DME?

There are times when insurance companies require the patient to pay for the equipment up front and be reimbursed for all the costs, or partial costs.

Some insurance companies require an adjuster to determine whether medical equipment is necessary. A good example is with Transcutaneous Electronic Nerve Stimulators (TENS). Some adjusters will attend actual patient visits and view x-rays before deciding as to whether the equipment is beneficial to the patient.

Once an adjuster agrees it is needed, the insurance company will likely pay the full amount.

Some patients prefer to purchase durable medical equipment out of pocket. They can even purchase over-the-counter durable medical equipment from your office or at the local drug store.

Items include knee braces, padded seats, blood pressure monitors, hot and cold packs, canes and many more.

The durable medical equipment industry is accelerating each year because people are choosing to be cared for in their homes.  If they do not have to stay in a hospital, they don’t. Another reason for DME use increasing is because the geriatric population is increasing.

People are living longer, but this may because they have the help of durable medical equipment and supplies, and better healthcare by physicians such as you.

Providing durable medical equipment to your patients is one way you can improve your services and show patients their health is a top priority.

Durable Medical Equipment - Injury | DroneBase

Durable Medical Equipment for Worker’s Compensation Patients

In the last few years, close to 130 million employees on both the federal and state levels were covered by worker’s compensation and many require the use of durable medical equipment.

According to the Occupational Safety and Health Association, companies pay around one billion dollars a week to cover medical costs and worker’s compensation for employees. The coverage seems well worth it in the workforce of construction and labor. But in the sedentary occupations such as secretaries or computer work, it has been an excessive cost for a minimal risk job.

The Economic Policy Institute reports there are 23,000 work related injuries per day in the United States. They also report that many workers develop illnesses on the job. These illnesses are costing employers even more money than injuries.

Most companies agree, however, that worker’s compensation is an effective way of avoiding a lawsuit from an employee. So just what are worker’s compensation benefits?

What are Worker’s Compensation Benefits?

Worker’s compensation insurance is purchased by employers. It is a temporary insurance program. It covers medical costs to employees who are injured while performing duties related to the job.

It can also replace part of the income that would have been made by the employee if they were able to continue working. In worse case scenarios, it can provide compensation to family members if an employee is killed on the job.

Worker’s compensation may also pay for any durable medical equipment needed by the employee to assist them with recovering from their injury.

The worker’s compensation program is state-mandated and employers who do not provide worker’s compensation can be susceptible to fines and even lawsuits.

What Type of Injuries Are Compensated?

Not every injury is covered under worker’s compensation. If you are an undocumented citizen, agricultural worker, or nanny, you are not covered for job-related injuries.

Most other types of jobs are covered. If the injury can be proven to be directly related to the job, it is covered. There are even times, like at company social events, where injuries can be covered, especially if the social event is a requirement of the job.

An example is if an employee falls off a ladder and breaks his leg while building a house for a construction company. Or, if someone develops carpal tunnel syndrome due to too much time spent typing or on the computer.

While there are many cases of fraud among scam artists trying to get money based on false injuries, most cases are validated.

Some injuries like this will require medical devices or equipment to help them in recovery. This equipment is often called durable medical equipment.

What is Durable Medical Equipment?

Durable medical equipment refers to items needed to assist people who are recovering from an injury they obtained while at work.

The equipment must be reusable and mostly for use in the home of the patient, or a long-term recovery unit of a medical institution. With in-home care services on the rise, so are the use of medical equipment needs within the home.

If a work-related accident requires in home care, worker’s compensation insurance can cover the costs of equipment needed by the patient and the caregiver.

Examples of Durable Medical Equipment

Common types of durable medical equipment include crutches, canes and walkers. Oxygen tanks and nebulizers are also considered durable medical equipment.

For those diagnosed with diabetes, blood glucose strips and monitors qualify as medical equipment allowed by worker’s compensation insurance.

Ventilators, hospital beds, and positive airways pressure machines are on this list. A person would also be allowed to have chair lifts, commode chairs and wheelchairs. Other thinks that are one-time use, such as prepackaged medication, would not count as durable medical equipment, but might still be covered under worker’s comp.

The list of durable medical equipment is extensive but this gives you an idea of the types of equipment allowed. If they are determined to be medically necessary for use in the home of the patient, and that it is necessary for treatment in recovery, it will likely qualify.

How Do You Get Durable Medical Equipment for Your Patients?

A face to face encounter with a patient is required in order for you to prescribe durable medical equipment. Once you determine your patient needs the device, you put in an order. Most doctors file claims for the patients whose insurance requires it.

There are times when insurance companies require the patient to pay for the equipment up front and be reimbursed for all the costs, or partial costs.

Some insurance companies require an adjuster to determine whether medical equipment is necessary. A good example is with Transcutaneous Electronic Nerve Stimulators (TENS). Some adjusters will attend actual patient visits and view x-rays before deciding as to whether the equipment is beneficial to the patient.

Once an adjuster agrees it is needed, the insurance company will likely pay the full amount.

You can acquire the assistance of specialists who provide the equipment for you. They can also assist with the claims and offer many benefits that ease your workload. These companies are like those who specialize in medication dispensing.

Instead of dispensing medications, however, they are dispensing durable medical equipment.

The Future of Durable Medical Equipment

Equipment used in helping people recovery from injuries, whether at work, at home or elsewhere, is expected to grow at an enormous rate. According to Grand View Research, the global market for durable medical equipment is expected to reach 242 billion by the year 2024.

Personal mobility devices are among the large types of equipment being needed by patients.

With the number of worker’s compensation cases expected to increase dramatically, you can also expect the number of care providers needed to increase.

When you first start working with a patient who has a work-related injury, it is just you, the patient, the adjuster and the company. Depending on the injury, you may also be looking at adding a case manager, physical therapist, occupational therapists, vocational therapists and more.

Therefore, it is even more encouraging to utilize the services of specialist companies who can take the reins on everything related to the case. This means they can work with the insurance companies, they can provide the medical equipment needed for recovery, and they can even help with billing and collections.

With your worker’s compensation patient numbers expected to increase, the number of durable medical equipment needs will increase also. Do what you can to minimize paperwork while maximizing time with your patients.