Home Forums Discussions Coding and Billing anyone billing for DME??

At my office, we have a company who "stocks" their nebulizers. We do all the work of providing nebulizers to our patients like providing education, fill out all paperwork etc. We don't get paid anything for this as the DME company gets paid by insurance companies. We continue to do it as a courtesy for our patients.

My question is, how do I become a credentialed DME provider so that I can bill for providing nebulizers? Is that even possible for a PCP to become a DME provider??

I worked in DME before going into an office setting. Let me tell you, it is really nice being able to say, "here's your script. Go to X-Y-Z and they'll take care of you and explain everything. They'll do a benefits investigation to see what your coverage is and they'll be able to tell you if you'll have any financial responsibility and whether or not your ________is covered with your insurance. You may have an out of pocket expense but they'll work that out with you."

That being said, DME billing is kind of a beast. Unless you are buying your own nebulizers from a wholesaler and retailing them outright. But if you want to be able to bill insurance companies for them, there's a monthly billing cycle involved and the product is "rented" for a full year before it is owned by the patient (unless that is strictly a CPAP machine rule - the rules are always changing). The forms for DME are different too. And they don't use CPT codes, they use HCPCS codes, so the code set is different. You'd likely need a Medical Supply Retail license and you'd have to see if your local health department requires you to have a sanitation program or something to that effect. And possibly clinical certifications. You may need a licensed respiratory therapist on staff to do the set-ups and patient training when dispensing a machine.

As commendable as it is that you're providing a courtesy to your patients, courtesy doesn't pay the bills.
I would do myself an favor and let the DME supplier handle it all since you don't get reimbursed for the time it takes to do the footwork.
Try contacting your local medical supply company, hospital organization or state health department and they may be able to point you in the right direction if you want to become credentialed and what the licensing process may be. I know in RI the process is rigorous, frustrating and the reimbursements are not worth the effort.

Thanks so much for the detailed answer.
On second thoughts, I won't try to get DME credentialed!!

I do a ton of DME in my office, but I do it with ortho braces. The credentialing isn't really that hard except for with medicare patients and I only have a handful of those and I have worked out a deal with my suppliers that with medicare patients, I give them the braces, but get all their info, and get them to sign a form and my DME suppliers will bill for the medicare ones if i write a script and the brace is just replaced in my office no charge because technically i didn't use that brace, the DME company did.

Now with nebs and such, I would find out how much of a mark up there is between buying the machines and what gets covered and how often they get covered. If there is a 200 gap then that is a lot of money to leave on the table.

The other way you can do it is that if you are actually stocking the DME stuff in your office for the company, you are supposed to charge them a "space rental fee". What you are doing is called Consignment. So you shouldn't be letting them use space in your office and getting to bill everything while you go through the hassle of all the paperwork (time is money) and they get to collect. So part of that fee includes what it takes to do the work.

I would be happy to speak to you more on it with details of your set up.