Avoiding Product Substitution with your DME Provider

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Avoiding Product Substitution with your DME
Provider
With new rules and regulations, product
substitution has been of utmost importance. This
is added with new reimbursements plans that quite
often lead to a loss of revenue. It ends up
affecting all physicians, patients, DME
providers, healthcare staff, etc. Every now and
then, product substitution occurs because many
physicians and/or patients are unaware of the DME
products (e.g. dressing supplies) that are
covered by medical insurance. Hence,
practitioners end up using inferior or
inappropriate products for patients. In most
cases, Medicare and other insurance providers
cover wound care dressing supplies under general
policies. But Medicare ensures that the size of
the dressing be matched to the size of the wound
for reimbursements. Other reasons why DME
products get substituted or understood
as DME provider not stocking the product is
mainly due to the deficiency of the apt product
receipt wherein in actuality, the requested
product is not covered as per the patients
policy/LCD (local coverage determination). Often,
the DME provider does not inform this to the
patient/healthcare provider (product is not
covered), hence ends up sending an
inferior/dissimilar quality and lesser number of
products as well.
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Avoiding Product Substitution with your DME
Provider
Sometimes, this is due to a simple reason that
the DME provider believes that since HCPCS codes
are the same for two different products, he can
send the substitute to the patient and not the
same make as the one directed by the health care
provider. Occasionally, DME providers carry out
this activity due to the substantial price
difference in the same product categories and
retain a profit margin whilst DME billing.   To
avoid these substitutions, a couple of aspects
must be looked into DME representative It is
important to know that DME providers do not work
with all insurance payers. Hence, creating
multiple relationships with varied DME providers
is an added advantage. Products Ensure that the
products frequently ordered are available at all
times with the concerned DME provider. Cheat
Sheets Creating these sheets can be handy for
the healthcare providers/staff to check if the
prescribed product is available with the specific
DME and covered/not covered by the insurance.
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Avoiding Product Substitution with your DME
Provider
Supply Ordering To send and receive orders in
the most time-effective manner, review the
ordering methods regularly (Email, fax, direct
EHR gateway submission, etc.). Supply Order
Form Ensure there is a DO NOT SUBSTITUTE
tagline on all orders and that the orders are
relatively easy and simple to understand (e.g.
include tick boxes for various selections).
Streamline the form and upgrade it at regular
intervals to best fit the needs of the health
care provider and DME ordering and regulating
procedures. Contact Person It is beneficial to
have a contact person who directly liaisons with
the DME representative at all times. All these
issues can contribute to well-established and
corrective patient care.