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It is often referred to as "durable" medical equipment (DME) as it is intended to withstand repeated use by non-professionals or the patient, and is appropriate for use in the home. Medical supplies of an expendable nature, such as bandages, rubber gloves and irrigating kits are not considered by Medicare to be DME.
In the US a certificate of medical necessity is a document required by Centers for Medicare and Medicaid Services to substantiate in detail the medical necessity of an item of durable medical equipment or a service to a Medicare beneficiary. [1]
The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the Children's Health Insurance Program (CHIP), and health insurance portability standards.
Template documentation Usage Although there are over two hundred Wikipedia guidelines, this sidebar contains the most foundational or frequently referenced, organized by the categories defined in Wikipedia:List of guidelines , some of which are headings and the others contained under the heading "Other".
Durable medical equipment (DME) is a category of medical devices designed to assist individuals with disabilities, injuries, or chronic health conditions. [1] These devices are prescribed by healthcare professionals and intended for repeated use over an extended period.
With the passage of the Balanced Budget Act of 1997, Medicare beneficiaries were given the option to receive their Medicare benefits through private health insurance plans, instead of through the Original Medicare plan (Parts A and B). These programs were known as "Medicare+Choice" or "Part C" plans.
When providers agree to accept an insurance company's plan, the contractual agreement includes many details, including fee schedules which dictate what the insurance company will pay the provider for covered procedures, and other rules such as timely filing guidelines. Providers typically charge more for services than what has been negotiated ...
NCQA's web site includes a summary of HEDIS results by health plan. NCQA also collaborates annually with U.S. News & World Report to rank HMOs using an index that combines many HEDIS measures and accreditation status. The "Best Health Plans" list is published in the magazine in October and is available on the magazine's web site.