What Does DME Stand For in Healthcare?

Posted By Steve Alder on Aug 7, 2024

DME in healthcare stands for durable medical equipment – defined by CMS as equipment that is used for medical purposes by an individual who is sick or injured and that can withstand at least three years of repeated or frequent use. However, in the context of healthcare compliance, it can be more important to understand the HIPAA status of DME suppliers.

One of the reasons it is important to understand what does DME stand for in healthcare is that suppliers of durable medical equipment qualify as healthcare providers under §1395x(s) of the Public Health and Welfare Code. This means that, if a supplier of DME conducts electronic transactions covered by Part 162 of the Administrative Simplification Regulations (i.e., as a Medicare-enrolled DMEPOS supplier), they qualify as a HIPAA covered entity.

If a supplier of DME qualifies as a HIPAA covered entity, this has an impact on when it is permissible for a healthcare provider (who also qualifies as a HIPAA covered entity) to disclose Protected Health Information (PHI) to the DME supplier without a HIPAA authorization. It may also have an impact on how much PHI can be disclosed to the DME supplier depending on the purpose and the circumstance of the disclosure.

What Products Qualify as DME in Healthcare?

CMS has a useful webpage that explains what does DME stand for in healthcare and lists examples of Medicare-covered DME. By combining these examples with publicly available claims data, it is possible to determine what products qualify as DME in healthcare and which are most used:

Oxygen Devices and Accessories
Wheelchairs and Accessories
Walking Aids and Other Mobility Devices
Hospital Beds and Commode Chairs
Lower Extremity Orthotics (i.e., braces, splints, etc.)
Knee, Ankle, and Foot Orthotics
Wrist, Hand, and Finger Orthotics
Blood Sugar Meters and Test Strips
Patient Lifting Equipment
Infusion Pumps and Supplies

It is important to be aware that this list of products that qualify as DME in healthcare does not include durable medical equipment patients may have purchased directly from a DME supplier without going through Medicare or an insurance provider. In circumstances in which DME is purchased directly, the DME supplier may or may not qualify as a HIPAA covered entity depending on the nature of their other business activities.

Why the HIPAA Status of a DME Supplier Matters

HIPAA covered healthcare providers are permitted to disclose PHI to other HIPAA covered entities for treatment, payment, and healthcare operations. This means – for example – a surgeon can disclose PHI to a DME supplier (that qualifies as a HIPAA covered entity) in order to determine the appropriate size of device being implanted into a patient. In this scenario, PHI is being disclosed for treatment purposes and the minimum necessary standard does not apply.

However, the minimum necessary standard does apply if a HIPAA covered healthcare provider discloses PHI to the same DME supplier to ensure payment for the healthcare service provided. Similarly, the minimum necessary standard applies to disclosures to DME suppliers (regardless of their HIPAA status) permitted by §164.512(b) of the Privacy Rule to report an adverse event, to enable a product recall, or to track the performance of an FDA-regulated product.

In other circumstances, it may be necessary for a HIPAA covered healthcare provider to enter into a Business Associate Agreement with a (non-covered) DME supplier before disclosing PHI. For example, if a HIPAA covered healthcare provider approaches a DME supplier and requests an estimate of how much using a particular medical device could save – and the DME supplier requires access to PHI to provide the estimate – it will be necessary to enter into an Agreement.