How Does the Medicare DME PPS Work?

The Centers for Medicare and Medicaid established the prospective payment system (PPS) for home health agencies (HHAs). Medicare pays an HHA each month for home health services provided to qualified patients. The services covered through PPS include nursing and therapy services, medical supplies, home health aides and medical social services. Often a doctor will prescribe DME (durable medical equipment) such as canes, walkers, hospital beds or wheelchairs for homebound patients. The HHA bills Medicare directly for home health services and DME as long as they are medically necessary.

Instructions

• 1

  Obtain a prescription from your doctor or treating practitioner for the DME.

• 2

  Choose an HHA that is approved by the Medicare program and that can provide all the home care needed, including staff, medical supplies and DME.

• 3

  Request a statement of services covered by Medicare before care begins. The HHA must explain verbally and in writing what portion of your bill is covered. You may be charged if you have not met your Medicare deductible.

• 4

  Review the Medicare coverage plan to determine if the DME will be rented or purchased. The equipment will become the patient's property if purchased.