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December 31, 2020 Workers' Comp

Unlocking the DME "Black Box"

In science and computing, a black box is defined as a device, process or system, whose inputs and outputs are known, but whose internal workings are often not well understood.

Durable Medical Equipment “Black Box”

According to this definition, Durable Medical Equipment (DME) has traditionally operated as a black box of sorts for claims adjusters in the workers’ compensation space – and with justified reason.

As a specialized area of ancillary services, DME’s inner workings are complex. There is a wide range of equipment. Within each category, there’s a significant number of products that vary in nuanced ways, with many products offering slightly different functions. As a result, costs run the gamut, and coding gets complicated with a “miscellaneous” code used for products that aren’t easily categorized.

From the adjusters’ perspective, the DME black box has known “inputs” and “outputs,” which we’ll review, but the “inner workings” can often be shrouded in mystery, which we’ll outline and unlock in this paper.

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