Understanding the intricacies of durable medical equipment (DME) is crucial to streamlining claims, optimizing costs and facilitating patient recovery. Here are five essential insights that adjusters should keep in mind when an injured employee requires DME for one or more products.
1. DME Product Expertise Is Crucial
The variety of DME products is vast, ranging from specialty rehab equipment like lift chairs and specialty beds to electrotherapy units and prosthetics, with multiple options existing for most. A deep understanding of these products, their functions and their applications is needed. Adjusters should partner with specialty providers like Apricus Specialty Solutions that have extensive DME experience, knowledge of common injury services and educational resources to assist in determining the appropriate solution for each injured employee’s needs, to facilitate DME orders and to address cost considerations.
2. A Broad Network Offers Advantages
Access to a national network of credentialed DME vendors ensures equipment is delivered promptly, meets all requirements and is cost-effective. DME networks allow specialty providers to manage all fulfillment and billing and to work with dedicated vendors that meet the needs of virtually any type of injury. These programs can also deliver outstanding results related to in-network penetration, decrease costly out-of-network activity and improve injured employee satisfaction. A well-vetted network provides peace of mind and considerable savings off fee schedules.
3. Improve Outcomes Through Comprehensive Care
Injured employees often require both medical and specialty solutions simultaneously. Effective collaboration between case managers and specialty solutions providers ensures that DME needs are integrated into the injured employee’s overall care plan. Specialty DME care coordinators also facilitate and communicate with adjusters, case managers, injured employees and their families to ensure care is coordinated with all parties involved. This coordinated approach leads to better outcomes, timely services and cost savings.
4. Harness the Power of Injured Employee Satisfaction
Engaging with injured employees to confirm they have received their DME, understand its use and are satisfied with the product is vital for promoting optimal outcomes. When questions arise, injured employees and adjusters can talk to a knowledgeable care coordinator that can assist with product and service questions. When needed, a specialty coordinator can facilitate monitoring of DME product warranties and maintenance to ensure the injured employee’s DME is satisfactorily maintained. This positive patient experience can influence the recovery process and overall claim resolution.
5. Optimize Costs Without Compromising Quality
Managing DME expenses can significantly reduce medical costs. A specialty solutions provider like Apricus Specialty Solutions can achieve this by submitting pre-authorized DME plans, negotiating optimal rates, blocking auto refills, capping rental costs, offering generic substitutions and applying retrospective savings through bill reviews. These measures help avoid unauthorized orders, reduce administrative hassles and prevent overcharging. Having a care coordinator to help facilitate the appropriate DME products also promotes savings. Injured employees who receive unsuited products can incur costly replacements, delays in recovery time and extended return-to-work, which can increase overall claims costs.