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DME Benefit Management

directDME offers quality durable medical equipment and complementary services that reduce claims costs and protect the client’s financial resources. Maintaining a balance with efficient cost containment for the customer, directDME delivers quality, timely services to the claimant—always with maximum productivity and return to work as the ultimate goals.

Expense controls inherent to directDME’s formulary-based DME Benefit Management program reduce the client’s average medical spend to 3% which is 600 basis points below the industry average of 9%. Program features and benefits that generate these considerable savings include a unique pricing structure, effective cost containment programs, proprietary medical management protocols, comprehensive network management, integrated administrative processes, as well as continuous care coordination.

directDME’s innovative solutions to the industry’s escalating DME costs produce positive results with direct impact on claims’ outcomes. Successful cost containment programs with demonstrated savings include:

  • Capped pricing below fee schedule for many commonly used items.
  • Product Substitution Program based on established formula to identify and recommend lower cost brand or generic alternatives.
  • Blocked savings from pre-authorization process for closed or denied claims and non-applicable injuries.
  • Capped Rental Programs managed to prescribed durations with all rental month fees applied to the purchase price.

Utilizing skilled staff and numerous company resources with extensive medical experience and product knowledge, directDME effectively manages product quality and service utilization.

  • Utilization Review to determine medical necessity within appropriate treatment guidelines and clinical protocols.
  • High dollar DME audits for medical appropriateness and relevance to identify and propose product alternatives.
  • Diagnosis and body part information compared to specific claim detail to identify unrelated items.
  • Care coordination with all stakeholders, such as case managers, home health nurses, and discharge planners, to ensure continuous comprehensive care and proper facility-to-home-to-work transitions.

With simplified ordering and streamlined procedures, directDME’s service standards offer additional levels of control for managing the claimant’s care.

  • DME orders actively driven through a comprehensive national network of credentialed providers that meet delivery and quality assurance standards.
  • Resupply and duplicate order management to ensure only appropriate and necessary orders are filled and to monitor misuse, control utilization and eliminate redundancies.
  • Integrated processes with ancillary service providers including large national clinic networks, IME/FCE providers, PT clinics, and home healthcare to provide seamless service and continuous care.
  • Order monitoring with claimant follow-up to ensure satisfaction, answer questions, assist with compliance and to proactively identify any potential issues.

directDME has designed a successful pricing structure for clients to be confident they are getting the best price available.

  • Pricing consistent with state fee schedule or usual and customary levels.
  • Price Guarantee—if an identical DME product is priced lower, directDME will beat the price by 5% of the difference.

Backed by Service Promises, clients can expect premier service that is managed strictly to service standards created to match the clients’ needs.

  • For DME, home/vehicle modifications and hearing aids, directDME will deliver the right product at the right price. If the product delivered is incorrect, the replacement product will be discounted by 10%.
  • For transportation services, the driver will arrive within 15 minutes of the scheduled time. Failure to do so will result in no charge for the service. Any charge for a missed appointment as a result of failure to meet this promise will be paid by directDME.
  • For language translation services an interpreter fluent in the requested language or with the necessary qualifications to provide the service will arrive within 15 minutes of the scheduled appointment.  Failure to deliver on this promise will result in no charge for the service.  Any charge for a missed appointment as a result of failure to meet this promise will be paid by directDME.
  • For home health care directDME will deliver the right service at the right price.  If an identical service elsewhere is priced lower directDME will beat the price by 5% of the difference.

Contact us today at 877-496-7461 to take advantage of these cost containment programs or for more information contact your account representative at sales@directdme.com.