Becoming an Authorised Medicare Supplier of DME:
Now, let’s explore the process of becoming an authorised supplier of Durable Medical Equipment (DME) through Medicare. While Medicare authorization is crucial for DME, it’s important to note that not all insurance carriers require it. Cash patients and those with carriers like Aetna, Cigna, Blue Cross Blue Shield, and United Healthcare often don’t need Medicare certification.
DME, or Durable medical equipment billing services, includes items designed for repeated use, serving a medical purpose and enhancing daily activities for injured or disabled individuals. These items must be appropriate for home use and improve one or more activities of daily living.
Healthcare providers, including chiropractors, may need accreditation to become authorised DME suppliers. Ten organisations oversee the accreditation process, ensuring suppliers meet necessary requirements. Some providers are exempt from this process, like medical doctors, but if required, the accreditation may take three to four months and involves rigorous training and site visits.
Surety Bond Requirement:
DME suppliers subject to bonding requirements must obtain and submit a $50,000 bond for each National Provider Identifier (NPI) number. Physicians and non-physician practitioners may be exempt based on specific conditions. It’s crucial to use Medicare-authorised surety bond companies to avoid application denials.
Recent Changes for Chiropractors:
Chiropractors were recently affected by changes in Medicare’s DME application processing. While eligible to enroll as DME suppliers, chiropractors are no longer exempt from accreditation, surety bonds, or site visits. These changes came into effect on June 30, 2013
After completing accreditation, chiropractors need to apply for a DME PTAN (Provider Transaction Access Number) through the Medicare 855S form. This 39-page application requires basic information, professional licences, and other documentation. While there’s an enrollment fee, some organization’s may waive it.
Once approved, chiropractors receive a new DME PTAN number. It’s essential to submit claims to the correct Medicare carrier assigned to the state for DME billing services, different from the carrier used for regular Part B claims.
Becoming an authorised Medicare supplier of DME involves a comprehensive process, including accreditation, surety bonds, and proper documentation. Despite the complexities, offering DME services can enhance patient care and provide an additional income stream for chiropractors. To ensure compliance, it’s crucial to check with carriers and conduct thorough research before submitting claims.