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DME defined as designated health services (DHS) and the In-office Ancillary Services (IOAS) including delivery

Are all DME including therapeutic diabetic shoes amd inserts considered DHS? If so, then how is reimbursement handled in a group practice? Also, according to the attached article the group amd the physician both must be registered with DMERC to dispense DME. Is that correct? In a group practice should every location or office be registered with DME? That is, should every location have a supplier number? And if so, then if a physician is dispensing diabetic shoes/inserts in the office and will be reimbursed by Medicare and is not a registered as a supplier with DMERC is that a breach of the Stark Law? Also, some DME vendors provide direct ship for certain DME products such as dressing supplies, compression garments, etc to the patient home. Is that no longer legal under the Stark Law or that dependent on who is billing for the DME? And can a DME vendor provide any sort of compensation to a physician who is allowing to bill for the DME, but the physician delivers to the product in the office?

https://www.healthlawadvisor.com/physicians-beware-groups-providing-dme-prosthetic-devices-and-other-medical-supplies-to-their-medicare-patients-risk-violating-the-strict-liability-stark-law-since-the-expiration-of-covid-19-public

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Comments (1)

paulkesselmandpm

This cannot provide you with a thorough explanation, for that a heath care attorney who has license to practice in your state is mandatory. This forum can provide you with these facts:

Not all DME are designated as DHS.

Some examples of DME which are not DHS are surgical dressings and therapeutic shoes. The latter is not even technically DME, as it is a Congressional carve out within Part B Medicare. There are others but they don't affect podiatrists. Hence there is no preclusion contained in the DHS language which effects surgical dressings or therapeutic shoes. This allows you to drop ship surgical dressings as they don't need to be provided by the designated health provider (you). It also allows you to get into trouble by shipping shoes, but of course the LCD says you have to heat mold the inserts or make sure they are full contact. Can you advise me how you can heat something remotely and make sure that our most vulnerable patients are protected?

Compression garments are considered similar to surgical dressings and thus not DHS designated.

What is most important to you is how the pie is spit up and if incentivizing for various other categories (AFO's, Lower Limb Prosthesis, TENS, etc.) are considered DHS and how they are split.

Also, since they are DHS why you not your assistant must acutally dispense or its potentially a violation of the ancillary rule

As for locations, I suggest every practice location enroll. For the few hundred dollars spaced out over three years, its not worth the hassle of your patients having to be funneled to one office or the potential slip up, which has happened of one staff member asking the DME inspector, when will you inspect our other office. This scenario has repeated itself several times, with the result of practices being banished from MCR for more than a year.

Lastly, it is the practice which enrolls not the individual provider. Think of yourself as a store, whether it is one person or 10, it is the "store" which is enrolling.

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