D+WC has the subject matter expertise to assist providers, payers (insurers and self-funded/administered employers) and consumers in the difficult task of technology assessment for medical necessity determinations in order to ensure that patients receive the appropriate DME for their individual and unique medical needs. This is both good business and good medical management because it protects consumers.
DME is a rapidly escalating medical cost line item substantially driven by 79 million aging baby boomers combined with manufacturers and supplier response through the development and distribution of a seemingly inexhaustible diversity of products. Many of these products lack scientific basis for their use especially, those frequently seen on late night infomercials starring celebrity or pseudo-celebrity pitchmen and women. For some, technology represents a panacea while for others, an adjunct to medical interventions.
The need to determine the medical necessity and appropriateness of DME items is critical for both medical mainstream technologies, e.g. O2 concentrators, orthotics and prosthetics, wheelchairs (both manual and power operated) as well as the aforementioned class of devices.
Some DME can actually exacerbate an existing problem or create a new one especially, ill-fitting orthotics and prosthetics.
Consumers or patients themselves should have a vested interest in only paying for medically necessary and appropriate DME since it is they who ultimately pay through; denial of services, self-payment (medical savings accounts) , shared risk (higher co-pays & deductibles, limitation in medical benefits and ultimately, through the pain and disability associated with poorly managed conditions.
The Centers for Medicare & Medicaid Services (CMS) has extensively discovered DME abuses through collaboration with the Government Accounting Office, Office of the Inspector General, U.S. Postal inspectors, and multiple fraud and abuse task forces, the FBI, State Attorney Generals, Medicare DMERCs and intermediaries. However, many of the DME abuse patterns have been found to be common in automobile and workers’ compensation medical systems.