DME’s help improve the quality of the patient’s life at home

Description: The patient must be incapable of performing routine activities without the DME

 What is a DurableMedical Equipment?

Introduction

Any medical equipment used in the home in order to help in a better quality of living can be called as durable medical equipment (DME). This includes iron lungs, oxygen tents,power scooters, Nebulizers, catheters, hospital beds, wheelchairs, walkers, and portable oxygen equipment.

Characteristic Features of a Durable Medical Equipment

An equipment is called as a DME, if

  • It is primarily used  for medical purposes and is meant to be used for medical purposes
  • If it can be subject to repeated use
  • In the absence of a medical condition, this equipment is of no use to the person
  • It is designed to be used in and around the home

DMEPOS

Certain insurances cover prosthetics, orthotics and certain other supplies, which are collectively denoted as POS, under durable medical equipment. These are devices that can replace missing body part, and support or correct any bodily malfunction.

Equipmentthat are Not Durable Medical Type

  • Items that are use-and-throw are not durable medical equipment; some examples are surgical face masks, incontinence pads and leggings.
  • Items that are not appropriate to be used at home, such as paraffin bath units and oscillating beds.
  • Items that need to be used under medical supervision or under medical institutional settings
  • Items that are not intended to be used in the home but are primarily used outside the home.
  • Items used for convenience rather than medical need.  Some examples are stairway elevators, bathtub and toilet seats.

Qualifying for a DME

Any person can purchase durable medical equipment on a prescription from his treating physician. For one to qualify for a DME reimbursed by his or her insurance the following criteria need to be met:

  1. The equipment must be a medical need for a normal living.
  2. It must meet the definition of durable medical equipment.
  3. The physician must justify that the DME is a requirement to safety and effectively treat the patient.
  4. The patient must be incapable of performing routine activities without the DME
  5. The physician must prove that the absence of the DME significantly hampers the patient’s normal living.
  6. The patient must be able to operate, or use the equipment without any assistance.
  7. The equipment must be safe enough to be used in a home environment.

Exceptions

Some insurance companies cover certain disposable items as a part of durable medical equipment reimbursement if they can significantly lower the risks associated with the medical condition and or if they are important preventive care measures. Some examples are nondurable items such as lancets and test strips used for glucose testing in diabetics.

 

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