AANA Lab Course 1002 -3rd Annual Fellows/Chief Residents-DMEPOS Billing and Coding-Chris Morris & Zach McLeese

DMEPOS Billing and Coding-Chris Morris & Zach McLeese

Pdf Summary

This document from Breg, Inc., a leading U.S. provider in orthopedic bracing, durable medical equipment (DME), and healthcare consulting, outlines key information on DMEPOS billing and coding to support healthcare providers in managing durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).<br /><br />Breg emphasizes its position as a top industry player with 1,800 employees, including clinically trained consultants and billing advisors, offering products such as slings, braces for upper and lower extremities, spine supports, cold therapy, and post-op immobilizers. They provide both outsourced and in-house bracing program options to healthcare practices.<br /><br />The outsourced program offers cost savings by shifting inventory ownership to third parties, reducing costs by 70-80%, simplifying inventory management, and eliminating billing and collections responsibilities—a low-risk solution with no revenue generation. Conversely, the in-house program allows practices total control over patient care, billing, and revenue, enhancing patient compliance and satisfaction, with potential annual revenue up to $83,000 per orthopedic surgeon and profits of $40,000 to $50,000.<br /><br />The document stresses the importance of compliance and documentation, including standard written orders, proof of delivery, advanced beneficiary notices, and clinical documentation that substantiates medical necessity, referencing local coverage determinations (LCD), especially for items like knee braces.<br /><br />Breg identifies challenges in the current healthcare landscape, such as varied insurance plans, rising patient financial responsibilities, and frequent Medicare guideline changes, but maintains that DMEPOS billing remains profitable and valuable.<br /><br />Success relies on adequate staff training, clear processes, provider education, consistent audits, and communication across clinical and billing teams. The document also dispels myths about DMEPOS billing, citing CMS rulings supporting physician involvement in furnishing DME to their patients for better care continuity.<br /><br />In sum, Breg advocates for informed program selection, diligent compliance, and strategic operational control to optimize revenue, patient outcomes, and practice efficiency in DMEPOS management.

Keywords

Breg Inc

orthopedic bracing

durable medical equipment

DMEPOS billing

healthcare consulting

outsourced bracing program

in-house bracing program

compliance and documentation

Medicare guidelines

patient care management