Durable Medical Equipment (DME): Coding & Billing for Hospitals
& Physicians Ensuring Compliance
Objectives: At the completion of this program, the participant will be
able to:
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Discuss the concept of true DME versus implantable
DME and devices
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Explain how DME is classified under the Medicare
program
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Discuss the DMEPOS fee schedule and payment for
DME
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Identify the purpose, functions and process of being
a DME supplier
-
Describe the process of filing the CMS-855-S for
enrollment as a DME supplier
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List who can bill what DME and to whom the DME should
be billed
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Review the various Level II HCPCS codes for DME
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Appreciate Medicare's extreme compliance concerns
concerning incorrect payment for DME
-
Review specific compliance concerns relative to
dispensing DME
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Explain how both hospitals and physicians become
involved with DME
| PROGRAM TOPICS |
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DMEPOS – What Is
It?
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Definition of
DME
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Categorization and
Classification of DME
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Sources for
Information
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Payment System
Interfaces
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Compliance Overview
– False Claims
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DMEPOS Fee
Schedule
• Coding And
Billing for DME
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DME Billable by
Physicians To Carriers
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DME Billable by
Hospitals To Fiscal Intermediaries
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DME Billable Only To
DMERCs
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Level II HCPCS
Codes
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Charge Master
Setup
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Common Items for
Hospitals
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Common Items for
Physicians/Clinics
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Implantable Devices,
DME and APCs
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Prosthetics/Orthotics
– PT/OT Interface
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2-Day DRG Rule for
DME
•
Administrative/Organizational Concerns
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Obtaining a Provider
Number
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CMS Form 855-S
– Key Elements
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Dispensing Location
Concept
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DME Closet Concept -
ED
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Associated DME
Companies
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Freedom of Choice
Concept
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Inpatient DME
Suppliers
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Under Arrangement DME
Supplier
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Alternative
Approaches
• Examples/Case
Studies
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Physicians Dispensing
DME
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Hospital ED
Dispensing Crutches/Canes/Walkers
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PT/OT Custom
Splinting – Therapy-Only Codes
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PT/OT –
Prosthetic/Orthotics
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Wheelchair
Clinics
• Compliance
Considerations
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REGISTER
Credit Card - FAX 781.272.0466
Check Payable to MHA - MAIL
MHA Education Department
5 New England Executive Park
Burlington, MA 01803-5096
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