Dme pickup agreement form

As with most aspects of medicine, the Centers for Medicare & Medicaid Services (CMS) has created rules and regulations for DME. First, the agency has guidelines for what qualifies as DME under Medicare. The equipment must be durable (can withstand repeated use and generally lasts at least three years), used for a medical reason, not typically useful to someone who is not sick or injured, and used in the home. 1

DME that meets this definition and is medically necessary is covered under Medicare Part B. Medicare sets an approved price for each type of equipment. Patients have to pay 20% of that amount, and their Part B deductible applies as well. Coverage varies somewhat based on the type of DME (for example, patients may be eligible to have some items replaced sooner than others). Although private insurers tend to use Medicare as a guide, they may have their own rules about what is covered and what isn't. All of this has implications for patients' upfront and ongoing costs.

STREAMLINING THE PROCESS

Given the complex nature of DME, it is not unusual for care teams to struggle with the approval process. Certain strategies, however, can make it easier.

Apply Lean principles. A group at Cincinnati Children's Hospital Medical Center used Lean methodologies (a set of principles for achieving efficiency commonly used in the corporate world) to standardize and streamline its DME ordering process. 2 By using value stream mapping, a time study, and flow diagrams, the team identified the parts of the process that needed improvement, including initial processing, obtaining signatures, returning forms, and uploading completed documents. After the implementation of standard practices, the group's median lead time for DME requests (the time between receiving and completing them) decreased from 50 days to three days. The median processing time (the time staff worked on each request) decreased from 14 minutes to nine minutes, leading to a cost savings of $11,000 a year.

Develop a staff expert. Some tasks within a medical practice need to be spread across a large number of staff or geographic regions. But ordering DME is one task that may be accomplished more efficiently when it's funneled through one or a few staff members who already have experience and expertise, or can quickly gain it. Given the complexity of regulations and variation between orders, having one or more people well-versed in DME will quickly pay dividends. Someone who knows all the rules can expedite the DME process and keep everyone from going down a path that leads nowhere. In our large academic family medicine practice, we designated management of our DME processes to a full-time registered nurse, with some support from medical assistants working under her guidance.

Reverse the process. Once you have your DME expert in place, consider reversing the typical ordering process. Instead of the physician (or qualified health care professional) readying the order and passing it off to staff for fulfillment, have staff ready the order based on the physician's documentation and then route it to the physician to co-sign before sending. (See “Ideal DME workflow.”)

Standardize documentation. A key aspect of DME billing and approval is physician documentation of the medical need for the equipment. For some items, documenting that need is straightforward (such as a patient who needs a prosthetic limb due to a recent amputation). In other cases, it may not be. We've found that the DME items with the most complicated requirements are wheelchairs, hospital beds, gel overlays, and oxygen. So, for these items, we've developed templates of the information required in progress notes for face-to-face encounters. Power mobility devices like scooters can also be difficult to get approved because of the many regulations that govern them. Therefore, we've created a separate table with a brief summary of the Medicare requirements that guide patient eligibility, plus templates to aid in ordering mobility devices and documenting the need for them (see “Power mobility devices”).

DME DOCUMENTATION TEMPLATES

Patient has mobility limitation that significantly impairs ability to participate in ADLs (activities of daily living).
Patient is unable to use cane or walker.
Patient has sufficient upper extremities function and mental capabilities needed to safely self-propel manual wheelchair.

Due to [diagnosis] patient requires a semi-electric hospital bed to position the body in ways not feasible with an ordinary bed.

Patient requires positioning of body to relieve pain.
Patient requires traction equipment, which can only be attached to a hospital bed.
Patient requires frequent changes in body position.
Patient has an immediate need for a change in body position.
Patient requires the head of the bed to be elevated more than 30 degrees most of the time due to congestive heart failure, chronic pulmonary disease, or problems with aspiration.

Gel overlay is required due to limited mobility.

Patient has pressure ulcer on trunk or pelvis.
Patient has impaired nutrition status.
Patient has incontinence.
Patient has altered sensory perception.
Patient has compromised circulatory status.

Patient is at 88% or below oxygen saturation (O2 sat) on room air at rest.

Patient has impaired O2 sat with ambulation (six-minute walk test). (Add “on [amount] liters per minute” to document need for increased flow if patient is already on oxygen.)

In-person visit with physician to address mobility needs.
History and physical exam by physician or other medical professional (recommend consulting physical therapist) focused on assessment of mobility limitations and needs. Exam results must be recorded in medical record.
Order (prescription) may be written after in-person visit and mobility exam. (Required elements at right.)
Order and documentation of visit and exam must be sent to supplier within 45 days of exam.

Patient requires a power mobility device due to diagnosis of: [diagnosis]
Patient requires power mobility device now due to change in: [condition].
Patient has history of falls/poor balance.
Patient has decreased upper extremity strength and/or grip strength.
Patient is currently unable to get to the bathroom to toilet/bathe at home.
Patient is currently unable to get to the kitchen to prepare meals at home.
Patient is currently unable to get to the bedroom to groom/dress at home.
Patient is willing to use power mobility device in the home.

Patient has received the following treatment: [treatment]
Patient is currently using the following medications: [medications].
General: no apparent distress, well-kempt.
Neuro: gait, balance to be evaluated by physical therapist.
Musculoskeletal: sitting in wheelchair.

See history/exam for diagnosis that requires patient to have power mobility device.
Patient is being evaluated for power mobility device.
Patient cannot use a cane/walker due to history of falls and [lower extremities % function].
Patient cannot use a cane/walker due to poor balance.
Patient cannot use a manual wheelchair due to [upper extremities % function and/or grip strength].
Patient cannot use a manual wheelchair due to contracture of hands and pain level of [x/10].
Power mobility device is necessary in the home to get to the bathroom to bathe/toilet.
Power mobility device is necessary in the home to get to the kitchen to prepare meals.
Power mobility device is necessary in the home to get to the bedroom to groom/dress.
Patient cannot use a POV due to lack of postural stability.
Patient cannot operate POV tiller.
Patient requires special seating due to pressure sore.
Power mobility device will improve patient's ability to get from bed to bath.
Patient can safely operate power mobility device.
Patient is willing and motivated to use device in home.
Referring patient to PT/OT clinic for face-to-face exam.
After evaluation by PT/OT will order power mobility device.

Standardize ordering. Given the amount of information required in many DME orders, it is helpful to have templates that prompt you to enter required elements for a given piece of equipment (we have included some of our own in this article). Some orders may need to include a patient's height and weight, for example, while others need to have the date of last office visit. Many EHRs can be set to alert you when a required piece of information is missing.

Based on CMS guidelines, discussions with DME companies, and expertise from DME clinical staff, we have compiled a list of 10 commonly required elements for Medicare coverage of DME.

TEN COMMONLY REQUIRED ELEMENTS FOR DME ORDERS

Equipment description
Dispense quantity and number of refills
Anticipated length of need (estimated in months, enter “99” if indefinite)
Diagnosis and ICD-10 code
Most recent height
Most recent weight (if > 300lbs, include “bariatric size” in equipment description)
Patient name and date of birth
Home address
Insurance company
Member ID

The five DME items most commonly ordered in our practice are rolling walkers, canes, incontinence supplies, nebulizers, and commodes. We've created templates for these orders that include many of the required elements. (See “DME ordering templates.”) We've also included templates for ordering wheelchairs and hospital beds — items that aren't as common for our practice but may be useful for practices with more elderly or frail patients — and a generic template for “other DME.”

Cane	Rolling walker	Nebulizer	Incontinence items
– Order specifics – EQUIPMENT DESCRIPTION: Cane Dispense: 1 with 0 refills Anticipated length of need: 99 [or fewer months if temporary] DIAGNOSIS (and ICD-10 code): Difficulty walking (R26.2) Height: Weight: – Demographics – Patient name: DOB: Home address: Insurance info: Member ID:	– Order specifics – EQUIPMENT DESCRIPTION: Rolling walker Dispense: 1 with 0 refills Anticipated length of need: 99 [or fewer months if temporary] DIAGNOSIS (and ICD-10 code): Difficulty walking (R26.2) Height: Weight: – Demographics – Patient name: DOB: Home address: Insurance info: Member ID:	– Order specifics – EQUIPMENT DESCRIPTION: Nebulizer machine with neb kits, tubing, and filters Dispense: 1 machine and appropriate supplies Anticipated length of need: 99 [or fewer months if temporary] DIAGNOSIS (and ICD-10 code): [diagnosis] FOR USE WITH: [medication type and dosage] Height: Weight: – Demographics – Patient name: DOB: Home address: Insurance info: Member ID:	– Order specifics – EQUIPMENT DESCRIPTION: Incontinence suppliesDispense: [amount] with [number] refills Anticipated length of need: 99 [or fewer months if temporary] DIAGNOSIS (and ICD-10 code): Mixed incontinence (N39.46) Height: Weight: – Demographics – Patient name: DOB: Home address: Insurance info: Member ID:
Commode	Wheelchair	Hospital bed	Miscellaneous
– Order specifics – EQUIPMENT DESCRIPTION: Commode Dispense: 1 with 0 refills Anticipated length of need: 99 [or fewer months if temporary] DIAGNOSIS (and ICD-10 code): Gait and mobility abnormalities (R26.9) Height: Weight: – Demographics – Patient name: DOB: Home address: Insurance info: Member ID:	– Order specifics – EQUIPMENT DESCRIPTION: 1 wheelchair and supporting equipment (light/standard weight wheelchair with anti-tippers, seatbelt, cushion, and elevating leg rests) Dispense: 1 with 0 refills Anticipated length of need: 99 [or fewer months if temporary] DIAGNOSIS (and ICD-10 code): Difficulty walking (R26.2) Height: Weight: – Demographics – Patient name: DOB: Home address: Insurance info: Member ID:	– Order specifics – EQUIPMENT DESCRIPTION: Hospital bed Dispense: 1 with 0 refills Anticipated length of need: 99 [or fewer months if temporary] DIAGNOSIS (and ICD-10 code): [diagnosis] Height: Weight: – Demographics – Patient name: DOB: Home address: Insurance info: Member ID:	– Order specifics – EQUIPMENT DESCRIPTION: [description] Dispense: [amount] with [number] refills Anticipated length of need: 99 [or fewer months if temporary] DIAGNOSIS (and ICD-10 code): [diagnosis] Height: Weight: – Demographics – Patient name: DOB: Home address: Insurance info: Member ID:

IN SUMMARY

Getting patients the DME they need can be an arduous process, but these items are often life-changing. Developing standard templates for common DME orders and designating a staff expert to shepherd those orders to quick fulfillment can increase your practice's efficiency in this area, cutting costs and improving quality of care.