Durable Medical Equipment
What Is Durable Medical Equipment?
Durable Medical Equipment in the auto accident context is usually a back brace, neck brace, or TENS unit. It is perfectly legal to prescribe your patients this type of medical equipment if (1) you document the medical necessity, (2) charge a reasonable rate, and (3) don’t prescribe it for every patient so as to create a pattern that “a majority of your patients receive medical equipment.”
General Considerations When Supplying DME:
You should always document the medical necessity for the equipment. Use common sense, if someone complains of a level 2 pain- please don’t prescribe them a $1,000 back brace.
You should not provide the medical equipment unless it is reasonable, related, and necessary. Keep in mind that even if it is reasonable, related, and necessary, your insurance companies will red flag you if “almost every patient” receives it. This is the world you live in.
Pigs get fat and hogs get slaughtered- remember that when you set your pricing. In my opinion, charging $500-$1,000 for a TENS unit or back brace is normal and insurance companies will live with it. Charging anything more than $1,000 is a red flag. Charging $2,000 or more is going to raise some eyebrows and open some investigations. Keep in mind that everyone, including the insurance companies, has access to the internet. They can search the internet and find out how much that TENS unit or back brace sells for online. If you want to charge Geico or State Farm $2,000 for a device that anyone can purchase online for $20 then you will be investigated.
You should take one-on-one time to educate the patient about the benefits of the equipment, why you are providing it to them, when they should use, and how they should use it. If your patient shows up at an EUO with the equipment untouched, unopened, and in the original plastic wrapping then that is a problem for you. Remember that educating the patient is part of the reason that you can charge more than you paid.
You should hand your patient a form listing the billed amount of the equipment before charging your patient and have them sign a form acknowledging this. Handing your patient a TENS unit and then billing their insurance company for it is unethical (although not illegal) in my opinion because you don’t inform them of the cost and that they can decline receipt of the equipment.
You should not provide medical equipment on the first day unless there is a valid reason. The DME is expensive and it is possible that the patient’s condition will improve without the DME. First, there is not enough documentation supporting that the patient will benefit medically from the equipment. Second, if the majority of your patients receive DME on the first day, the insurance companies can red flag you.
You should not provide a TENS unit to a patient while they are treating at your office three times a week for electrical stimulation. If you genuinely feel the patient needs the TENS unit then write something in your notes like “the patient’s pain is reduced immediately following electrical stimulation in my office so I am providing a TENS unit for the patient to be used on days when he/she can’t come in for treatment.”