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November, 2013

DME: What You Should Know

By Denise Vuich, DC

There is some confusion out there about DME – what it is technically, who can sell it and what a chiropractor needs to do in order to sell and get reimbursed by Medicare. There have been recent changes and health care providers need to be aware of the appropriate procedures necessary to prescribe and utilize DME.

DME is an acronym for durable medical equipment. DME are home care products that are used to improve and maintain patient wellness and adherence to care. DME products include LSO braces, TENS/Garment units, cervical traction, knee bracing, and ankle and foot orthoses.

Patient treatment outcomes can be vastly improved when DME is prescribed and utilized by the patient per their doctor's instruction. DME also increase patients' compliance, which leads to them "taking part" in their own health efforts, leading to better results and an increase in patient retention. (We all know how hard it can be to generate new patients; if we have improved patient retention, then we don't need to keep adding as many new patients.)


According to the Medicare website, Medicare Part B (medical insurance) covers durable medical equipment (DME) that your doctor prescribes for use in your home. Only your doctor can prescribe medical equipment for you. DME meets these criteria:

  • Durable (long-lasting)
  • Used for a medical reason
  • Not usually useful to someone who isn't sick or injured
  • Used in your home

tens unit - Copyright – Stock Photo / Register Mark DME and the DC

It has been claimed that chiropractors cannot be involved in prescribing DME. That is false, provided you follow the correct protocols and procedures. If you do, DME can be a great supplement to a practice's bottom line.

There are a myriad of chiropractors who benefit greatly by participating in the Medicare DME program. The reimbursement levels can be quite attractive to the practice.

Prior to Medicare changes, DCs could be certified as Medicare DME providers by completing three application forms, paying the fee, and possibly experiencing a visit – unannounced – to the practice office. The process was relatively simple and was completed in four to eight weeks (assuming the DC proved the necessity of the DME products and had the required forms in place.) However, with the recent alterations, chiropractors now have to perform accreditation, which can last from two to four months.

It is far more complex, time-consuming, and frankly, a much bigger headache. What was once a straightforward, easy-to-traverse process has become quite burdensome and fairly laborious. But that doesn't mean it can't still be accomplished.

The time has come and passed (June 30, 2013) for chiropractors who were DME-certified to be re-accredited or lose their Medicare DME certification. But even if a DC lost certification, they can always go back and re-apply. And the advantages of selling DME can certainly be worth having to jump through all the hoops. Those who do secure accreditation will benefit from the compliance with current regulations.

These requirements are relevant to the general practice procedures from many third-party payers and are required for compliance with Medicare DME standards. Your chances of passing a surprise audit (pop quiz) will be significantly improved. This facet alone is a phenomenal reason to achieve accreditation.

In this age of ever-increasing government regulation, it makes sense to not fight the tide and pursue higher compliance to increase your chances of providing useful products to your patients, while not rocking the boat on proving medical necessity.

In the near future, all healthcare practices may have to offer accreditation in order to treat any patients. The whole process is not going to be simpler or less costly than it is currently, but this is the impact when any alterations in Medicare occur. All chiropractors can indeed be certified; it just takes a little more time and effort to go through the process. In this time of decreasing revenues, adding DME to your existing patient load can add clinical benefits, increase patient compliance, and enhance revenue.

The revenue part is particularly important in these tough economic times and significant change in health care. Let's take a look at how you can market DME in your practice.

Marketing DME

Obviously, internal referrals are most effective, but in order to have a wide-ranging referral system, doctors must market themselves to other healthcare providers, as well as the general public. And dealing with and prescribing DME is no different. You need to ensure your health care peers, who have patients who could be aided by your DME, are up-to-speed with your current offerings. For example, perhaps an MD has patients who could benefit greatly from an LSO brace.

Dollars and Cents

Another factor to consider is the added financial gain you achieve from adding DME in your practice. Each of our patients benefits from using orthoses, braces and/or supports to assist in healing and rehabilitation. And the reimbursement from Medicare for some of these products can be rather significant, especially with LSO braces. Some LSO back supports achieve reimbursement as high as $1,000 per unit. Adding this line of DME can add a significant annual increase in collections, while greatly enhancing the level of care and well-being to the patient.

Improves Compliance and Patient Satisfaction

Patient satisfaction is crucial in order to maintain a healthy doctor-patient relationship; the use of DME aids on this front. Bottom line: If you improve the patient's wellness and quality of life, they won't ever forget you.

The DMEs you decide to carry must offer a true and significant improvement over your patient's conditions. If you offer a product that greatly relieves pain, etc., you will create a patient who will want to tell the world how much better their life is because of the product you've introduced to them.

For instance, if you provide a lumbar support that allows Mrs. Smith to work in her rose garden again, she will "spread the word" to all her family and friends. This is an outstanding source of word-of-mouth advertising, and as you know, that is some of the best marketing you will ever experience. Patients who get results refer others to your office!

Accuracy of Services

A practitioner/clinic must represent accurately what services they provide, how those services are provided and the clinical results of those types of services. This is required in order to effectively communicate to the patient population exactly how healthcare providers help the patient achieve overall health and well-being. In other words, take all the mystery out of the equation. It is better for all involved, from the patient to the government to the insurance providers to your practice.

It is critically important to maintain your level of knowledge and awareness of new products – including DME – that can aid your patients in attaining and maintaining wellness. This, in my estimation, is the goal of all practitioners: to help as many as possible achieve their maximum level of short- and long-term health and wellness. DME can be a large piece of that effort, improving patients' lives and helping your practice become as successful as possible.

Dr. Denise Vuich is the president and executive director of Vuich Vendor Services and is currently in private practice in the Los Angeles area. She maintains a concierge practice focusing on family chiropractic and nutritional counseling. Her education began at Penn State University, where she majored in biology and physiology; and continued at New York Chiropractic College, where she completed her doctorate in chiropractic. Reach Dr. Vuich with questions and comments at

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