DME MEdical Billing

Confuse about Medicare will pay or not for patient’s DME equipment in a senior living Center or Nursing Home?

Original Medicare coverage for patients in continuing care facilities can be onerous to sort through for the purchase of Durable Medical Equipment (DME) items. We are here to provide help. This article will talk about how you will find out who is eligible, which items are covered, and what to do if the patient has a Medicare Advantage Plan.

The Initial 100 Days

Nursing homes and long-term care facilities can provide for a large number of patient needs. However, if patients require the use of an item that is not being offered by the care facility or the patient is transitioning to a new facility, the foremost question to ask is how long the item will be needed. For like 100 days, Medicare Part A will cover DME claims of your patient with real Medicare. During this time, patients can rent or buy DME equipment. It is important to note that you must be able to show documentation from the patient’s doctor explaining that the DME item is necessary to improve the patient’s quality of life in order to avoid denied claims. Moreover, all DME items covered are expected to last at least three years and should not be used for non-medical purposes. In other words, Medicare expects equipment to be durable and only used as intended by the patient. 

After 100 Days

If the DME item is used past the initial 100 days, the remarkable question you should ask is if the patient plans to stay at a nursing home or senior living centre as a primary residency. For patients who have transitioned to long care, showing documentation to the care facility will not be able to provide the item and this states that DME item is still required by the patient as noted by the concerned doctor. Items such as a continuous passive motion (CPM) machine which the doctor seems only necessary for the first 100 days will no longer be covered. 

DME Items Pertained By Original Medicare

Hospital Beds

Pressure Reducing Bed

Suction Pumps


Mattress Overlays

Traction Equipment

Blood Sugar Monitors

Blood Sugar (glucose) Test Strips


Commode Chairs

Nebulizer Medications


Items not covered are

Daily medical items used at home are not typically covered by Medicare. This includes first aid items like band aids, gauze, and everyday medical care needs that are low in cost and easily available. Such items should be billed to the patient.

What happens when a patient already has a Medicare advantage plan?

In case you don’t have original Medicare available, kindly contact your supplier immediately and ask for “utilization management “. This term applies to the process Medicare uses to make sure the item is necessary, durable, and can be used appropriately as intended. Suppose accepted then restrictions may apply that have to be taken care of and is to be discussed with the patient.

Can a Patient avail oneself any Supplier?

Medicare will only cover DME items sold by registered suppliers. They should meet certain guidelines and get approved by Medicare. All the suppliers will have a subscriber number which will be required for the claim submission.

Natural Disaster Exceptions

For patients residing in an area that has been declared a national disaster-impacted area by the government, there are some exceptions allowed to the Medicare restrictions. Temporary aid may be provided to patients who have lost their DME items or whose equipment was destroyed or severely damaged during the disaster. Medicare has limitations on coverage, physician database, physician fees, suppliers, and location, depending on the event and exception allowance regulations.


Natural Disaster Exceptions

To sum up, Medicare can be helpful for patients who are in need of costly durable medical equipment at home as long as they meet the requirements for purchasing or renting the items. For matters of billing, it is advisable to become familiar with the Medicare website, DME guidelines, and claims submission format. If any questions? We are here to help! Our experienced team will assist you with services such as consultations, coding, payment posting, credentialing, audits, or AR and rejection management. Use our contact form online to tell us about your billing concerns and you will have an idea of how affordable and effortless it is to work with AccQdata Billing and Consulting team. We only work with DME billing, so your payments will be timely and accurate, leaving you to spend more time doing things that you love! To know more about our service or doubt you can Call us: +1-866-631-3108.