{"id":8776,"date":"2023-02-14T12:28:46","date_gmt":"2023-02-14T12:28:46","guid":{"rendered":"https:\/\/legionhealthcaresolutions.com\/blogs\/?p=8776"},"modified":"2023-02-14T12:28:47","modified_gmt":"2023-02-14T12:28:47","slug":"basics-of-preauthorization-for-dme","status":"publish","type":"post","link":"https:\/\/legionhealthcaresolutions.com\/blogs\/basics-of-preauthorization-for-dme\/","title":{"rendered":"Basics of Preauthorization for DME"},"content":{"rendered":"\n

Preauthorization is a process through which a request for provisional affirmation of coverage is submitted for review before a durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) item is furnished to a beneficiary and before a claim is submitted for payment. Preauthorization helps ensure that applicable coverage, payment, and coding rules are met before supplies are delivered. Preauthorization may be needed before certain services can be rendered or equipment supplied. Every insurance company has its unique guidelines for preauthorization for DME, still, in this article, we shared the basics of preauthorization for general understanding purposes.<\/p>\n\n\n\n

DME coverage is subject to the member\u2019s benefit plan. Members may be responsible for paying a portion of the DME\u2019s cost in the form of a co-pay\/coinsurance and\/or deductible. Generally, the DME provider will notify the member when co-pays\/coinsurance and\/or deductibles are due. You can submit a pre-authorization\u00a0request in multiple ways. Most insurance companies accept preauthorization requests for DME through online (provider portal); by fax; and by phone. You will receive notification about pre-authorization requests by fax, via\u00a0standard U.S. mail; and online (provider portal). In the event there is an urgent request for equipment requiring preauthorization that needs to be ordered on a weekend or on a holiday, most of the payers provide an emergency prior approval phone line.<\/p>\n\n\n\n

Key Elements of Preauthorization for DME<\/h2>\n\n\n\n

1. DME Preauthorization Request Checklist<\/h3>\n\n\n\n

DME preauthorization request checklist list includes the preauthorization request form; certificate of medical necessity; written prescription; and patient\u2019s medical records with details (such as diagnosis, patient history, physical exam findings, progress notes, medication list, wound or incision\/location).<\/p>\n\n\n\n

2. Certificate of Medical Necessity<\/h3>\n\n\n\n

The requesting physician, not the DME supplier, is responsible for completing the certificate of medical necessity for all prescribed DME items. The certificate of medical necessity may, however, be submitted by the requesting physician, discharging facility, or DME supplier. A preauthorization request submitted without a certificate of medical necessity will be denied for lack of information. Waiting to submit the preauthorization request until this is ready will save time and reduce rework. Filling out the certificate of medical necessity form involves:<\/p>\n\n\n\n