To put it mildly, the durable medical equipment (DME) marketplace can seem convoluted. Many patients have complicated requirements when it comes to these products, which could include oxygen, wheelchairs and medical supplies.
In fact, it can be difficult for many insurance carriers to stay completely up-to-date with the DME industry, especially in terms of technological advances and new regulations. Medical insurance professionals are usually more knowledgeable about hospital-related issues.
National and Local DME Vendors
Some DME vendors offer a wide variety of supplies, while others specialize. Furthermore, some are large national organizations. At the same time, many health insurance companies rely on smaller vendors to deliver these products, particularly in rural places. One thing for sure is that no single DME vendor can provide all the possible equipment and service combinations that patients may need after they’re discharged from the hospital and while they’re recuperating at home. These combinations aid daily living, including circumstances that involve long-term care and chronic conditions.
Unfortunately, given the general lack of oversight within this marketplace, some small vendors feel free to set whatever prices they’d like.
Making matters worse, dishonest sellers can commit DME fraud through various tactics. For example, scammers might intentionally send patients more items than they need or supply low-quality products while charging for higher quality.
A vendor might also convince a patient to buy a customized product like a custom-made wheelchair when such an item just isn’t necessary. Naturally, the customized version will cost considerably more.
Reining in Costs
For a long time, the insurance industry had been paying less attention to DME expenses than to doctor and hospital expenses since the latter group costs so much more. But in recent years, many insurance companies have begun to understand that DME costs can take a major financial toll on both the carrier and the insured.
The good news is that insurance providers have efficient tools at their disposal to lower these costs and ensure quality DME for their patients. For one, a DME benefits manager (DBM) will work with a network of vendors that adhere to a set of fixed prices as well as specific performance and quality measures. In addition, a DBM assists with controlling costs by ensuring appropriate utilization of services and also incorporates techniques such as identifying unbundling and unnecessary usage of not-otherwise-classified (NOC) procedure codes. These and other costly provider billing practices have become commonplace within the DME industry.
The DBM Ideal
In all of this, top-notch DME benefit management programs share certain qualities. They partner with reliable providers, have effective expense controls in place, offer highly managed DME coverage and make their claim adjudication process comply with state regulations. Please note that Northwood has put together just such a program.
Additionally, it’s helpful when Northwood contacts patients after their DME deliveries. That way, staff members can make sure that patients are satisfied with the products and services and determine if they have any questions or concerns. Likewise, Northwood staff members follow up to determine if patients still need their DME, monitor rental periods and supply quantities to control claims costs.
Northwood accomplishes the above goals by keeping abreast of the latest DME developments, monitoring their vendors carefully and incorporating steps to identify and avoid abusive practices. By accomplishing these tasks, payors will control medical costs while serving the patients’ needs.
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