Challenges and Opportunities of DME Practice
                     
Challenges and Opportunities of DME Practice
The necessity of Durable Medical Equipments (DMEs) had never been so high – in the U.S. 30% to 54% of 
those over 65 years have some form of disability; around 75% to 90% of such disabled require some form of 
DME to keep them mobile or enabled.  It is also estimated that around 1.5 million people are currently in 
need of wheelchairs and braces. And, when you add the population that is likely to be in need of other forms 
of durable medical equipment – prosthetics, orthotics, and supplies (DMEPOS) – it will be some opportunity 
for people involved in Durable Medical Equipment Practice Services: physicians, pharmacies, and 
manufacturers/suppliers. But, because DME services are physician-recommended, we are more interested in 
how physicians themselves can recommend, source, and administer DMEs.
While physicians can benefit immensely from an integrated DME management, there are challenges on the 
way – being equipped with a Medicare-enrolled and recognized pharmacy, sourcing supplies from bidders 
authorized by CMS, and showing up as participating suppliers, who accept Medicare-approved fees on DMEs.
Physicians who are willing to have pharmacies attached with Medicare Part B approval need to have full-
fledged Medicare Part B recognized DME supplies.  The importance of having Medicare-approved DMEs at
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Challenges and Opportunities of DME Practice
your pharmacy is that it enables patients to have access to DMEs that are fully covered and reimbursed from 
Medicare Part B.
DMEs cannot be freely traded at your pharmacy; you need to apply for authorization from CMS. First, you 
need to apply by filling up Form CMS-855S for all likely suppliers of durable medical equipment, prosthetics, 
orthotics, and supplies (DMEPOS). Applications are verified by National Supplier Clearinghouse (NSC) before 
being certified for compliance with DMEPOS Supplier Standards, as set forth in 42 CFR 424.57
Browse All: DME Medical Billing
Physicians in DME services are expected to be responsible – being responsible means agreeing to accept 
Medicare-approved amounts as full payment. Physicians that accept this clause will stand to collect only 20% 
of the approved amount after the patient has paid the part B deductible. Though not mandatory, being a 
partner in sharing monetary responsibility may have disguised benefits, such as goodwill and patient-initiated 
referrals.
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Challenges and Opportunities of DME Practice
While suppliers recognized by CMS are generally dependable, there have also been cases of sub-standard 
supplies. Accepting any supplies without thorough inspection may prove to be clinically inapt or 
underperforming.  Therefore, physicians from time to time need to verify suppliers’ credentials and report 
cards as and when they are published by CMS.
Notwithstanding these possible challenges ahead, physicians in DME services should have ample scope for 
revenue generation. Consider the scenario when Medicare will be extended to every U.S. citizen – with a 
majority of current Medicare beneficiaries yet to utilize DME benefits, Durable Medical Equipment Practice 
Services itself will be a major attraction amongst practitioners. And, with strategic partnerships with medical 
billing providers, physicians can expect to overcome these incumbent challenges and become more than 
being just survivors.
Medicalbillersandcoders.com has always responded positively to every clinical and operational challenge. 
Whether it is billing and coding, EHR implementation, or ICD-10 transition, we have been the first to assume 
responsibility. Medical practices of varied sizes and disciplines across the 50 states in the U.S. would readily
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Challenges and Opportunities of DME Practice
endorse us as the most dynamic and comprehensive source for overcoming clinical and operational 
challenges. And, at a time when DME practitioners find themselves in between opportunities and challenges, 
we are hopeful of helping them overcome challenges and realize opportunities.
Medical Billers and Coders (MBC) is a leading medical billing company providing complete medical billing 
services. Our certified coders follow accurate DME billing and coding guidelines to ensure an accurate 
selection of procedure codes along with modifiers. To know more about our DME billing and coding services, 
contact us directly at [email protected] or call us at 888-357-3226.
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