OrthoRx

Questions to Consider if you Plan on Managing Your Own DME

BILLING / COLLECTIONS / CODING

1.	Is your collections staff educated on DME to provide Letters of Medical Necessity of specific braces for patients’ condition?
2.	Are you aware of individual payer’s authorization guidelines and medical criteria for DME?
3.	Do you understand what items have favorable reimbursement and what items generally provide little to no reimbursement?
4.	How will you keep up to date on coding changes for your DME services?
5.	Are you currently contracted to provide DME with your payers?
6.	Does your system allow you to generate reports to analyze your DME business by physician, product, bill charges vs. collections, etc.?
7.	Did you know that on average 50% of DME claims must be billed on paper with attachments?
8.	Do you know which of your payers can accept DME claims electronically?
9.	Did you know that billing for some DME items to federally funded payers is a violation of the Stark Laws and could result in significant monetary penalties and exclusion from the Medicare program?
10.	Do you have the resources available to investigate new products and codes as they present themselves in the market place?
11.	Have you reviewed codes you plan to provide with your current payers?
12.	Do you have a plan in place to appeal denials?
13.	Have you staffed your billing/collection department to handle the increase in patient bill inquiries due to providing DME services?
14.	How do you know what is an appropriate billed charge rate for DME?
15.	How often will you analyze your billed charge rates to insure your charges are appropriate?
16.	How do you plan to collect co-pays and deductibles?
17.	How do you believe your billing staff would respond if we were to remove all responsibilities for billing DME?

STAFFING

18.	Do you have experienced staff to manage your DME services?
19.	Do you have a qualified staff member dedicated and trained on the various products to fit and adjust all skilled braces as well as educate the patient on proper use of the products?
20.	Is the person/person’s fitting product able to educate the patient on their specific insurance benefits?
21.	Have you taken into account the overhead to run a comprehensive DME program on your own? Will you need to hire additional staff?
22.	Do you have the ability to staff for same day DME authorization?

INVENTORY

23.	Do you have a system in place to manage your DME inventory to minimize leakage and keep on hand inventory to a minimum?
24.	How do you plan to minimize inventory loss?
25.	Do you have an employee or system in place that will be able to successfully manage your inventory to avoid stock outs and expensive priority shipping?
26.	Are you having difficulty getting physicians to consolidate to 1 or 2 manufacturers to minimize inventory and simplify ordering?
27.	Do you have relationships with most of the DME manufacturers and understand the differences in their products to the extent you can answer the physicians questions?

After considering the questions above, do you still want to Do-It-Yourself?