Unveiling DMEPOS in Healthcare: An In-Depth Exploration

DME telehealth

In the vast landscape of healthcare, the term DMEPOS may sound like an acronym from a complex lexicon. However, understanding DMEPOS is crucial, especially for those involved in providing durable medical equipment, prosthetics, orthotics, and supplies. In this blog post, we’ll demystify the acronym, explore its significance, and delve into various aspects, including DMEPOS accreditation, Medicare DMEPOS application, DMEPOS bonds, and the intricacies of competitive bidding in this domain.

Decoding DMEPOS

DMEPOS stands for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies. It encompasses a broad category of healthcare items that serve a medical purpose, are durable, and are used repeatedly. This includes everything from wheelchairs, oxygen equipment, and diabetic supplies to orthotic devices and prosthetic limbs.

DMEPOS Accreditation

Providers of DMEPOS must adhere to strict quality standards to ensure the safety and well-being of patients. DMEPOS accreditation is a process by which healthcare suppliers are evaluated against established criteria to ensure compliance with Medicare standards. Accreditation is often required for suppliers to participate in Medicare, and it is an essential step to demonstrate a commitment to quality and patient care.

Medicare DMEPOS Application

For suppliers seeking to furnish DMEPOS items and services to Medicare beneficiaries, obtaining Medicare accreditation is a requisite. The Medicare DMEPOS application involves a thorough assessment of the supplier’s business operations, quality control measures, and adherence to applicable laws and regulations. Successful accreditation is a prerequisite for suppliers to bill Medicare for covered items and services.

DMEPOS Bonds

DMEPOS bonds, also known as surety bonds, are a financial requirement imposed by the Centers for Medicare & Medicaid Services (CMS) as part of the accreditation process. These bonds serve as a form of protection for Medicare and the beneficiaries. They ensure that suppliers comply with Medicare regulations, and in the event of non-compliance or fraud, the bond can be utilized to cover financial losses.

Competitive Bidding in DMEPOS

To control costs and improve the efficiency of DMEPOS procurement, Medicare has implemented a competitive bidding program. Under this program, suppliers submit bids to provide certain items in specific geographic areas. The competitive bidding process aims to secure quality items at lower costs for Medicare beneficiaries. It encourages suppliers to offer competitive prices while maintaining high standards of service and quality.

What Is DMEPOS: A Comprehensive Overview

At its core, DMEPOS represents a vital component of patient care, ensuring that individuals have access to durable medical equipment, prosthetics, orthotics, and supplies essential for their well-being. The comprehensive nature of DMEPOS encompasses a wide array of items that contribute to the comfort, mobility, and quality of life for patients facing various health challenges.

Conclusion

In navigating the intricate world of healthcare, understanding DMEPOS is pivotal for both providers and patients. DMEPOS accreditation, the Medicare DMEPOS application process, DMEPOS bonds, and the dynamics of competitive bidding collectively shape the landscape in which suppliers operate and patients receive critical healthcare items.

For suppliers, compliance with accreditation requirements and participation in Medicare programs not only opens doors to reimbursement but also underscores a commitment to delivering quality care. For patients, awareness of the significance of DMEPOS ensures access to reliable and high-quality medical equipment and supplies that can significantly impact their overall well-being.

As the healthcare industry continues to evolve, the role of DMEPOS remains integral in enhancing the quality of life for individuals with diverse medical needs. In embracing the principles and standards associated with DMEPOS, healthcare providers contribute to a system that prioritizes patient comfort, mobility, and overall health.

Everything About Florida Law Durable Medical Equipment

Durable Medical Equipment

If your healthcare business is unsure about Florida Law regarding durable medical equipment, legal compliance and licensure is a simple process that can save home medical providers tens of thousands of dollars every year.

What Is Durable Medical Equipment?

Defined by Medicare, durable medical equipment is defined as a piece of machinery that is used repeatedly for a medical purpose with an expeected lifetime of at least three years.

Let’s look at a few examples of durable medical equipment:

  • Hospital beds and air-fluidized beds.
  • Wheelchairs, electric mobility machines, and lifts.
  • Blood sugar monitor and test strips.
  • CPAP devices and CPM machines.
  • Crutches, walkers, and canes.
  • Oxygen equipment.

These are just a few of the types of equipment that fall under the “durable medical equipment” definiton in the state of Florida. If you believe that any equipment that your business provides to patients falls under the more general definition, reach out to Florida Healthcare Firm to find out what you need to do to protect your business from regulation violations.

What is the Florida Law of Return of Durable Medical Equipment?

In Florida, healthcare businesses that violate laws on durable medical equipment face hefty fines anad fees on top of legal costs.

For example, if you rent or sell durable medical equipment without proper licensure, it is subject to a punishable by a fine. Over time, it can add up to millions of dollars.

Is Your Business in Violation of Durable Medical Equipment Laws in Florida?

In the event that your business needs to rent or sell home medical equipment to patients, it is a good idea to have all your processes and protocols reviewed by a healthcare law firm that can ensure that you are in compliance, starting with proper licensure.

Find out how to protect your business from legal fees and fines by contact Florida Healthcare Law Firm.

DME: Medical Abbreviation

DME telehealth

When chronic ailments set in, the focus turns to care that supports comfort, symptom minimization, and stabilization. Especially for the elderly, the goal is often to stay out of medical facilities as much as possible and try to return to a normal life, preferably at home.

To this end, most medical facilities and providers work hard to set patients up with everything they need to manage their medical care safely and effectively at home. For some patients, this means quite a bit of equipment, known as durable medical equipment or DME.

What Does DME Stand for in Medicine?

DME is a medical abbreviation that stands for durable medical equipment.

What Is Durable Medical Equipment (DME)?

Durable medical equipment can include any medical equipment that is used to help someone manage their medical issues at home.

For example, DME might include the following:

  • Wheelchairs, walkers, canes, or crutches
  • Blood sugar meters and testing strips or other testing paraphernalia
  • Oxygen equipment
  • Continuous positive airway pressure machines (CPAP)
  • Hospital beds and commode chairs

Legal Issues and DME

For the most part, DME is covered by Medicare, making it easy for anyone to get what they need regardless of their financial status. However, there are situations in which the medical professionals who provide or prescribe the DME may face legal trouble.

The issues come for prescribing medical professionals if there is any perceived attempt to defraud the government of money. For example, if a doctor orders a patient to rent a bunch of DME from a company that is owned by a family member or a company they are invested in, this is illegal even if the patient genuinely needs the equipment. Should it be determined that the patient did not legitimately need the equipment or didn’t need to test as often as recommended, further charges may apply.

Owners of the business that rents the durable medical equipment to patients and their families may face litigation from the patient and/ or family members if the machinery malfunctions and causes harm to the patient or loss of life.

If there are recurring complaints from patients or their families about the quality of the machinery or the service provided by the company, it could result in an investigation, fines, jail time, and the business being shut down depending on the severity of the crime.

Be Proactive: Legal Support for the Medical Industry

If you are concerned that you or your business may be committing fraud or other acts that may result in litigation, set up a consultation with Florida Healthcare Law Firm today to discuss the changes you can make to protect yourself going forward.

If you are currently facing litigation or an investigation, Florida Healthcare Law Firm can help you respond to the charges and defend you, if necessary.

Call Florida Healthcare Law Firm today.

Healthcare Fraud Scheme Indictment Starts the New Year

The U.S. Attorney arrested 13 people in a $100 Million healthcare fraud scheme in NY and NJ involving automobile insurance claims.  Some of the facts alleged include—

  • Bribed 911 operators and hospital employees for confidential information of insured drivers
  • Unnecessary and painful medical procedures
  • A non-physician owning medical clinics
  • Paying hundreds of thousand of dollars to “runners” who used the money to bribe people

Healthcare businesses that largely serve people injured in motor vehicle accidents remain a top tier focus for law enforcement and special investigative units (SIUs) of insurers.  But so do many other providers in the healthcare sector, such as pharmacies, durable medical equipment (DME) providers, addiction treatment providers and labs.  Payer and governmental presumption is often that financial motives are driving clinical behavior, NOT documented medical necessity.  Hence the need for active compliance plans and policies and procedures that don’t sit on a shelf, but rather are woven into daily business and clinical operations.  Nothing less than the right contracts, the right compliance plan and the right business culture will establish and maintain a sustainable healthcare business!

Orthotics and Fitter Requirements – Clearing the Air for Medicare Enrolled DMEPOS Providers

dmepos orthotics

dmepos orthoticsBy: Michael Silverman

Also Available in Video Format!

With off-the-shelf knee and lumbar orthotics (HCPCS Code OR03) included in Medicare’s Round 2021 of Competitive Bidding (and thus ability to supply such devices to beneficiaries living in competitive bid areas limited to bid-winners), non bid-winning DMEPOS providers have been scrambling to find new revenue streams for their business models.

Many such providers are looking to continue providing orthotics – such as prefabricated (HCPCS Code OR02) or custom fabricated (HCPCS Code OR01) braces.

Unfortunately, a misunderstanding that could jeopardize Medicare billing privileges seems to be spreading. It pertains to DMEPOS provider personnel/fitter requirements to enable billing for such prefabricated or custom fabricated orthotics; allow me an opportunity to clear the air.Continue reading

A DME Fraud of Epic Proportions

dme telemedicine fraud

dme telemedicine fraudBy: Michael Silverman

Almost two years after “Operation Brace Yourself” regarding purported telemedicine and orthotic bracing fraud made national headlines, on February 4, 2021 the Department of Justice Announced that a major player in that fraud – Florida businesswoman Kelly Wolfe – recently pled guilty to criminal health care and tax fraud charges.

Operation Brace Yourself was a 2019 crackdown on the illegal use of telemarketing and telemedicine to generate fraudulent claims for DME orders, whose reach spanned continents and ultimate implications defrauded taxpayers out of billions of dollars.

According to the Department of Justice Press Release and Settlement Agreement, Mr. Wolfe was seemingly a significant mastermind in establishing hundreds of DME companies that went on to defraud US taxpayers and Medicare beneficiaries.

Here are some highlights of the recently signed Settlement Agreement between the United States DOJ, Kelly Wolfe and her company Regency, Inc.Continue reading

2021 Pharmacy Enforcement Actions in Full Swing

By: Michael Silverman

The new year has brought with it no lull in pharmacy fraud crackdowns and enforcement actions, with allegations related to over one billion dollars in false claims.

Here’s a breakdown of the latest:

Mississippi Man Sentenced to 18 Years in Prison and $287,659,569 in Restitution

This individual spearheaded a scheme involving kickbacks to marketers and prescribers to defraud TRICARE and other healthcare programs by submitting claims for unnecessary compounded medications, which also involved routine waiver of patient financial responsibility. Continue reading

Webinar | Adding DME to Your Chiropractic Practice

adding DME to your chiropractic practiceAttorney Mike Silverman of the Florida Healthcare Law Firm will be co-hosting with Board of Certification Credentialing Director Matt Gruskin for a special presentation exclusively focused on the the topic of adding durable medical equipment (DME) to a chiropractic office. As attendees may know, adding DME is a great way to impact a supplier’s revenue, but most importantly is a fantastic mechanism to provide more complete patient care and satisfaction.

During this “lunch n’ learn” Mike & Matt will break down the steps necessary for a chiropractic office to provide DME to its customers, be it cash paying, commercially insured, or Medicare patients alike.

April 16 @ 12:00 pm – 1:00 pm

Free

DMEPOS Round 2021 Competitive Bidding: Potential Pitfalls

competitive bidding

2021 competitive biddingBy: Matt Fischer

With the 2021 competitive bidding round on the horizon for durable medical equipment (DME) providers, both those that are established as well as those fairly new to the industry must take note of the potential pitfalls that may be encountered when competing to become a Medicare contract supplier.

The durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) competitive bidding program was first established by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.  Under this program, DMEPOS suppliers submit bids (i.e. applications) and compete to furnish specific items in competitive bidding areas commonly referred to as CBAs.  Additionally, suppliers are not just bidding for the rights to a particular CBA but also for a single payment amount that will replace the current Medicare fee schedule payment.  The payment will be determined by using the bids submitted.  As of December 31, 2018, all contacts have expired.  As a result, there is currently a temporary gap period.  The upcoming bidding process is loaded with requirements.  Therefore, compliance with each requirement is crucial.  Here are a few pitfalls to watch out for: Continue reading