MEDICARE ELIGIBILITY FAQ
Q. How do I obtain Medicare coverage for medical equipment I need in the home?
A. The first step is for your physician to prescribe the item. Once you have the initial prescription you can contact us for coverage. If the item is a Medicare benefit we will obtain additional paperwork required by Medicare from your physician.
Q. Who initiates the necessary paperwork?
A. We do. We forward the Certificate of Medical Necessity (CMN) or Written Confirmation of Verbal Order (WCVO) to the physician. The physician completes these forms and returns them to us.
Q. What do we need to begin processing your Medicare claim?
A. You can fax or email us the following information:
Full legal name of patient, address, phone number.
Full name, Telephone and fax number of prescribing doctor
Doctor's prescription for desired equipment, which must include patient's diagnosis.
Patient's Medicare number, which must include the alpha character after the number (A, B, D, etc).
Supplemental insurance information, if any.
Patient's date of birth.
Patient's height & weight.
Q. What is Covered by Medicare?
A. Medicare Part B helps pay for durable medical equipment, including;
Manual wheelchairs (capped rental item)
Some positioning devices such as seat and back cushion (diagnosis driven)
Walkers, canes, crutches
Seat-lift mechanisms for lift-chairs, patient lifts
Hospital beds, gel overlays and air mattresses (capped rental item)
Most of the equipment listed above have special coverage criteria. For details on whether you meet the requirement please contact Medicare or us AT (818)981-9906
Q. What is a capped rental item?
A. Medicare considers hospital beds, manual wheelchairs, air mattresses, as capped rental items. This means that Medicare pays for 13 months rental after which the equipment will become the patients. You must use a vendor that rents equipment and bills Medicare for the monthly payments in your area. We do not rent equipment over the Internet and do not bill Medicare for this type equipment on Internet sales. We advise you to seek a local dealer that rents since Medicare will require them to install and maintain this "capped rental" equipment. If you live in our local area please contact us for capped rental equipment.
Q. What is NOT covered by Medicare?
A. Equipment not covered by Medicare includes; adaptive daily living aids such as: reachers, sock-aids, utensils, bathroom equipment, incontinence supplies, compression socks. For more detailed information regarding coverage, call 1-800-MEDICARE.
Q. Does Medicare cover for items to be used in Nursing Home?
A. Home medical equipment must be appropriate for use in the home. Your "home" is your house, (including assisted living), apartment, a relative's home, a home for the aged, or some other type of institution in which you live. However, an institution IS NOT CONSIDERED YOUR HOME if it is: a hospital or primarily engaged in providing skilled or non skilled nursing care (this does not apply to certain supplies and equipment that are prosthetics, orthotics, and medical supplies).
Q. Are walkers and rollators covered?
A. Medicare will allow a walker/rollator every 5 years. They cover 80% of the allowed amount set by Medicare. This is usually about $130.00. Regardless of whether your rollator cost $150 or $350, the reimbursement amount is the same. Patient is responsible for the difference between what Medicare pays and the cost of the rollator
Q. Does Medicare cover Lift Chairs?
A. Only the seat lift mechanism on a lift chair could be considered medically necessary if all of the following coverage criteria are met:
뷪he patient must have severe arthritis of the hip or knee or have a severe neuromuscular disease.
뷪he seat lift mechanism must be a part of the physician's course of treatment and be prescribed to effect improvement, or arrest or retard deterioration in the patient's condition.
뷪he patient must be completely incapable of standing up from a regular armchair or any chair in their home. (The fact that a patient has difficulty or is even incapable of getting up from a chair, particularly a low chair, is not sufficient justification for a seat lift mechanism. Almost all patients who are capable of ambulating can get out of an ordinary chair if the seat height is appropriate and the chair has arms.)
뷤nce standing, the patient must have the ability to ambulate (walk).
Coverage of seat lift mechanisms is limited to those types which operate smoothly, can be controlled by the patient, and effectively assist a patient in standing up and sitting down without other assistance. Excluded from coverage is the type of lift which operates by spring release mechanism with a sudden, catapult-like motion and jolts the patient from a seated to a standing position. Coverage is limited to the seat lift mechanism, even if it is incorporated into a chair.
Q. Does Medicare cover Wheelchair Lifts and Ramps?
A. Medicare does not reimburse nor authorize the purchase of a lift for a wheelchair or scooter at this time. Such items are typically not considered a medical necessity because they can also be used by persons without a medical condition. Don't forget, Medicare covers items needed "inside" the residence.
Q. Do I have to pay the 20% co-payment to Medicare?
A. After you have met your deductible, you're still responsible for paying directly, or through supplemental insurance, at least 20 percent of the Medicare approved amount. This co-payment may not be dropped by the supplier except in hardship situations and only on a case-by-case basis.