Transcutaneous electrical nerve stimulation (TENS) units have become popular solutions to muscle pain. A user applies applicator pads to target areas, which are pulsed with electricity at adjusted intervals. The result is gentle and continuous muscle stimulation that can alleviate soreness without pharmaceuticals.
Due to the effectiveness, safety, and generally low cost of TENS units, more and more medical providers are selling them to patients and placing them on insurance billing codes. There is a problem, though it is illegal to sell and bill for a TENS unit, DME unit, or back brace in Florida without a specialized license. If you do not have a Florida Home Medical Equipment (HME) Provider License from the American Health Care Association (AHCA), then you are not legally allowed to provide patients with a TENS unit.
Insurance Company Denials & Other Reactions
Most major insurance companies have realized many medical providers are illegally selling and billing for TENS units. In response, they are denying Durable Medical Equipment (DME) coverage without the license.
At Ovadia Law Group, our Boca Raton PIP attorneys know of one doctor who is being sued by an insurance company for billing TENS units without a license. The law on needing the DME license is clear, but obscure, so most medical providers simply do not know about it. The purpose of this law is to enforce basic standards that will ensure quality home medical equipment, products, and services.
Even standardized braces and similar lumbar support devices that are not custom fabricated need special licensing, but doctors do not know it. If you buy back braces in small, medium, and large sizes, for example, those are not custom fabricated, even if there are straps that allow for size adjustment. If you go before a board with a standardized lumbar support or another DME, you will jeopardize your professional license, and could even be sued by an insurance company.
Getting the Right License from the AHCA
In order to get a Florida HME Provider License from the AHCA, you first need to know that there are fees associated. You are also expected to be able to prove you are a licensed medical professional, and that you have some understanding of DME items, TENS units, etc.
While it can be a frustration to get the appropriate licensing, it is definitely worth it. There is a maximum administrative penalty of up to $5,000 per unit sold if you are billing for TENS units without the license. You can also be charged for a second degree misdemeanor for the first violation, and a first degree misdemeanor for second and subsequent violations.
In recent events, Florida House Bill 1305/Senate Bill 996 reached Governor Rick Scott, and it would have allowed chiropractors to sell TENS units and lumbar supports to their patients. However, he did not approve the bill, choosing to veto it instead.
Do you have more questions or concerns about specialized TENS unit licensing in Florida? Call 1-855-875-0854 to contact Ovadia Law Group and request a free consultation. Our lawyers frequently work with medical providers to help them understand and stand up for their rights, especially in PIP claims after an insurance company tried to short them on billing.
