User Guide — DME FAQ

DME is an abbreviation for durable medical equipment. DME is medical equipment that is ordered by a doctor for a patient's use in the home. These items must be reusable, such as walkers, wheelchairs, or hospital beds. DME is paid for under Medicare Part B and Part A for home health services.

DMERC is an abbreviation for durable medical equipment regional carrier. A DMERC is a private company that contracts with Medicare to pay bills for durable medical equipment.

The Centers for Medicare and Medicaid Services (CMS) have regionalized the processing of Medicare claims for durable medical equipment into four durable medical equipment regional carriers (DMERCs). These carriers administer the processing of these claims for specific regions — Region A, Region B, Region C, and Region D.

Yes, if you bill DME. Any practice that bills for durable medical equipment must do so using a DME number.

The NSC is the CMS-approved organization that administers all provider/supplier number authorizations and performs account updates and maintenance. The NSC works closely with each DMERC to ensure continuity of provider/supplier information. For information about requesting an application, providers can contact the NSC at 866-238-9652.

For information about requesting an application, providers can contact the NSC at 866-238-9652. Please note that commercial payers may also issue DME numbers.

Enter DME numbers on the Payer Enrollment page. (On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Enrollment and Numbers, click Payer Enrollment.) On the Payer Enrollment page, you can select Medicare DME from the Payer menu, or you can click Add Billing Group to create a new row (select Medicare DME from the Payer menu in the Add Billing Group view).

Medicare requires DME orders to include the NPI. CMS recommends that you list the NPI next to the provider's signature on the order form.

You can use one of these magic words to update your clinical paper form for DME orders:

• {{ORDERSUPERVISINGPROVIDER_NPINUMBER}}
• {{APPROVINGPROVIDER_NPINUMBER}}

athenahealth selects order types for certain durable medical equipment (DME) documents, especially those that are often included on a prescription document with associated medications (for example, diabetic testing supplies and nebulizers). If athenahealth identifies one of these order types on an inbound fax, we classify the document as the DME order type and send it to your practice in review status, as usual.

A document is classified as durable medical equipment only if:

• The document is an order that was generated under the DME section of the Assessment & Plan.
• Document Services selects the DME Order Type Group when they process the document to your practice.

You cannot reclassify other documents to the DME document class.

Note: athenahealth does not select order types for renewals on any prescription or DME documents. For renewals, we send documents directly to your practice in the Prescription - Renewal class. You can then add a medication order type or change the type to the DME class.

Workflow scenario

1. athenahealth receives an inbound fax on your practice's behalf. The fax includes a prescription for a supply of DME, such as lancets.
2. athenahealth selects the clinical order type based on the prescription name on the document.
3. The document is classified as DME and sent to your practice for review.
4. Any inbound faxes that include both a medication and DME are sent as separate documents with the classification and order type selected.
   

You can submit a prescription for durable medical equipment (DME) via the Surescripts network. To qualify for Surescripts electronic transmission, the order type must be a supply (as determined by our medication library) and it must have either a UPC or NDC product code.

Note: Some prescriptions and durable medical equipment (DME) items do not require a National Drug Code (NDC) to order because multiple brands make identical items: for example, blood glucose test strips. You can order items that do not have NDCs through the Surescripts network, as long as the provider and pharmacy are both configured for electronic prescribing.

Surescripts requires that the Sig field be populated. If the Sig field does not contain data from previous orders or other sources, athenaOne automatically sets the field to "Use as directed" (athenaOne does not overwrite existing information). You can edit the Sig field, if needed.

Workflow scenario

1. In the Assessment & Plan section, search for the DME order that you want to place (for example, oxygen equipment).
2. Place and sign the order as you normally would.
   athenaOne electronically submits DME orders that are flagged as medical supplies. All other DME orders drop to athenaFax.
   Note: If your practice is configured to alter the routing logic for DME order types, that logic continues to follow the configured behavior.

You can submit orders for DME electronically to participating DME suppliers (check the list of connected suppliers on the Success Community). If one of your preferred suppliers is not part of our network, contact your Customer Success Manager to request that we add the supplier to our network.

To order DME electronically, you must have these roles or permissions:

• Clinicals: Order/Prescription Sign-off
• Clinicals: Use Interface-only Document Actions

Note: This feature is not available if you use athenaOne for Hospitals & Health Systems or if your organization has both ambulatory and hospital departments.

1. In the Assessment / Plan section of a patient's encounter, click the plus icon next to Diagnoses & Orders.
2. Search for and select the medical equipment.
3. Click outside the selector to close it.
4. Click the DME order to display the details.
5. If the correct receiver is not displayed in the Send to field:
1. Click the option to open the clinical provider selector.
2. Search for and select the DME supplier.
6. Complete the Sig and other remaining fields as needed.
   athenaOne automatically sets the Sig field to "Use as directed" (athenaOne does not overwrite existing information). You can edit the Sig field, if needed.
7. Click Sign Orders.