Practical Tips regarding Durable Medical Equipment
If you are here then you are a medical provider who prescribes DME and wants to avoid getting sued by an insurance company.
General guidelines to consider:
- Every patient is different. Some have level 1 pain in their low back and others have level 10. You can get away with providing a lot of treatment to a patient with a level 10 pain but it would be odd if you treated the patient with level 1 pain the same exact way.
Below are some things to consider when providing DME to your patients:
1. TENS units and Lumbar Supports are being provided on the first visit.
If you are providing DME on the first visit to all PIP patients then beware. The insurance company will say that you are racking up high bills for DME without seeing if the pain goes away after some treatment.
What if a patient treated for two weeks and their pain went away? Now they have this expensive piece of DME sitting around. They will say that you rushed to bill expensive DME without letting the patient fail conservative treatment first.
2 . Patients are receiving e-stim multiple times a week in the doctors office but are sold a TENS unit.
If the patient is coming to your office multiple times a week then why are you prescribing them a TENS unit? The insurance company will bring this up if they are smart. If the patient is benefiting from e-stim that is great but make sure you are prescribing the TENS unit at a time when they aren’t in your office 3-5 times a week. If so, specify why they need the device at home.
3. Every patient gets DME at the clinic regardless of the level of pain (minor-moderate-severe) and regardless of property damage (scratches vs total loss)
Would you prescribe DME to a patient with a level 2 pain in their low back if PIP wasn’t paying the bill?
Every patient at your office in an auto accident cannot receive DME. Some patients with higher pain levels will easily be justified in obtaining DME. But you should avoid prescribing patients expensive DME if they have low pain.
I get it, you take the patient’s complaints at face value. If they say it is a level 8 pain then you write down a level 8. But here is what I am saying—go outside and look at their car or look at the photos they took of their damaged car before you prescribe an expensive piece of DME to them. Before you explain a person with a 5 mph impact can injuries just remember that the insurance company will already be looking at this type of claim if there is low property damage and the point of this post is “ways to reduce getting sued”.
4. the same exact device is on Amazon/Walmart for $20 but is being sold for more than $1,000
Remember that pigs get fat and hogs get slaughtered. Also, remember that insurance companies have access to the internet. They can look up the device you billed $1800 for and see what it sells for online. Yes, included in your bill for DME is the time spent educating the patient how, when, and why to use it so you can charge more than you paid. However, if you want to avoid getting sued, my suggestion is to bill under $1,000. Let the doctors billing $1,800 for a $20 TENS unit get flagged and sued.
5. There is no written note/form documenting the medical necessity for the equipment.
If you are going to charge for DME you need to document the need for it. You should include the justification for it in writing. Simply billing the CPT code for it isn’t enough. The insurance company is paying you top dollar for the DME so make sure you document accordingly.