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In the United States, durable medical equipment has a distinct meaning within government healthcare assistance programs including Medicare and the Social Security Administration. For example, in order for equipment to match Medicare's definition of DME, it must match the following criteria: Durable (can withstand repeated use)
Out-of-pocket costs for DME. Original Medicare is composed of Part A, hospital insurance, and Part B, medical insurance.If a person has Original Medicare, then Part B provides the coverage for DME ...
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.
Medicare may only cover the cost of the lift-mechanism rather than the entire chair. Before Medicare can be considered for covering the cost, patients will need to have a visit with their physician to discuss the need for this particular equipment. The DME provider will then request a prescription and a certificate of medical necessity (CMN).
Lyndon B. Johnson signing the Medicare amendment (July 30, 1965). Former president Harry S. Truman (seated) and his wife, Bess, are on the far right.. Originally, the name "Medicare" in the United States referred to a program providing medical care for families of people serving in the military as part of the Dependents' Medical Care Act, which was passed in 1956. [7]
The DME scheme was reminiscent of Medicare fraud in South Florida in the 1990s before it spread to other areas of medicine, such as physical therapy, diabetic injections and mental health services.
Physician's News Digest article on Certificates of Medical Necessity; Statutory definition of a CMN at the SSA website; Medicare manual that provides exhaustive information about the practical use of CMNs, particularly section 5.3. This is the official source of information for contractors administering the Medicare system about the use of CMNs.
Four "Specialty MAC Jurisdictions" were also created to handle durable medical equipment and home health/hospice claims: Jurisdiction A—consists of all states in Jurisdictions 12, 13, and 14; Jurisdiction B—consists of all states in Jurisdictions 6, 8, and 15