DME Stark Exception

September 1, 2008

This issue keeps coming back on my radar screen: As a primary-care practice, we don’t have much DME that we give our patients, but we do provide crutches, neck, wrist, elbow, and ankle bracing, heel cups, and the like, and then bill the patient’s insurance accordingly.We have relatively few Medicare patients. When our Medicare patients fall, we usually recommend they go to the ER because of the likelihood of broken bones and other complications. So, giving DME to a Medicare patient is an infrequent occurrence around here.Up to this point, I’ve been assured that these kinds of DME are excluded from the phase III rule of Stark, as they are needed to assure that the patient can safely leave our practice. Do you agree that there are some “small DME” items that primary-care practices can still provide to Medicare patients while staying within the law?

Question: This issue keeps coming back on my radar screen: As a primary-care practice, we don’t have much DME that we give our patients, but we do provide crutches, neck, wrist, elbow, and ankle bracing, heel cups, and the like, and then bill the patient’s insurance accordingly.

We have relatively few Medicare patients. When our Medicare patients fall, we usually recommend they go to the ER because of the likelihood of broken bones and other complications. So, giving DME to a Medicare patient is an infrequent occurrence around here.

Up to this point, I’ve been assured that these kinds of DME are excluded from the phase III rule of Stark, as they are needed to assure that the patient can safely leave our practice. Do you agree that there are some “small DME” items that primary-care practices can still provide to Medicare patients while staying within the law?

Answer: Yes, there is an exception for ambulatory infusion pumps, blood glucose monitors, and a few other ambulatory devices necessary for the patient to be able to leave the office, such as crutches, canes, walkers, folding manual wheelchairs, etc. See page 79 of the Federal Register for further clarification.