 Medicare Claims
PHC is a licensed Medicare provider.
Of the products covered by Medicare, about one-half are eligible for reimbursement when purchased over the Internet. The half not eligible for billing are rental items through Medicare and should be acquired from a local provider that can maintain the equipment for you. Unfortunately, these (Medicare) Capped Rental items include manual wheelchairs, hospital beds, sleep/support surfaces, respiratory equipment, patient lifts and slings. Read below to see which products are eligible for Medicare reimbursement and what you must do in order for us to file your Medicare claim. |
|
|
 | We file Medicare claims on a non-assignment basis for products you purchase from us. |
| - On Non-Assignments Medicare reimburses the beneficiary directly.
- You must pay for non-assignment products up-front.
|
| What kind of claims do we file for products on our website? |
| | Medicare | YES | | Medicaid | NO | | HMO's | NO | | Insurance | NO |
|
| What products do we file Medicare claims for when purchased? |
| - Walkers & Rollators (non-assignment)
- Lift Chairs (non-assignment)
- Power Wheelchairs (non-assignment)
- Power Scooters (non-assignment)
|
| What about Manual Wheelchairs and Hospital Beds ? |
| - Manual wheelchairs and hospital beds are "capped rentals" with Medicare. We do not Rent. This means that you should contact a local dealer/provider that rents equipment. Unfortunately, you don't have much choice of which equipment you will receive.
|
| What about Bath products? |
| - Bath products are not covered by Medicare.
|
| Non-Assignment - How we file Medicare claims: |
| We file Medicare claims for Internet sales on a non-assignment basis. Non-Assignment means that you pay for the product up-front. We initiate the necessary paperwork and submit it to Medicare on your behalf. When filing on non-assignment, Medicare reimburses the beneficiary directly. You pay the full amount up-front. If you have secondary insurance you may contact them for filing procedures. In some cases Medicare automatically submits the claim to the secondary carrier.
|
| How to start the claim process: |
| - Doctor's prescription for the product. We cannot do anything until we have the Rx. The Rx must be dated before the product is delivered.
- Once we have your Rx we will mail you a Medicare Claims Packet. Then some of the forms included in the packet must be returned to us.
|
| Do you need a Certificate of Medical Necessity form (CMN) ? |
| - No. We provide you with the CMN. You simply give it to your physician to sign and return it to us. Our billing department files an electronic claim with Medicare for you.
- Remember, we mail you the CMN ready for your physician's signature. You do not need to download the CMN from our website except to review it.
- Want to see the CMN for your product? Sure. Click here to download a CMN forms
|
| Can you get pre-qualification with Medicare so you know if you will qualify for reimbursement? |
| - No, Medicare does not give prior approval except for high-end powered wheelchairs. If someone has told you otherwise, make the call to Medicare yourself, 1-800-MEDICARE
|
| How long does it take Medicare to reimburse? |
| - Depends on which product. Some take a relatively short time while others take longer.
- Walkers, Rollators, and Lift Chairs are straightforward products that reimburse in a relatively short time (4-9 weeks).
- Some Power products such as Electric Wheelchairs and Scooters generally take longer.
|
| What information do we need to file a Medicare claim? |
| Patient information: |
| - Patient's full legal name, address, phone number.
- Patient's date of birth.
- Patient's Medicare number (including the alpha character after the number).
- Patients height & weight.
|
| Read PHC's Privacy Notice and HIPAA Compliance: |
| |
| Physician information: |
| - Doctor's Prescription for the product. The prescription should include the patient's diagnosis.
- Physician's name.
- Physician's address.
- Physician's telephone number.
- Physician's fax number.
|
| The most common causes for delays in Medicare reimbursement. |
| - Doctor does not complete the required information on the CMN.
- Missing or inaccurate patient information.
|
| How do you get the information to us? |
| - FAX or mail the information to us: 214-265-7817
|
| Our mailing address: |
| PHC
attn: Medicare Processing
10362 Miller Rd
Dallas, TX 75238 | Medicare phone #: 214-265-7810 PHC Customer Service #: 214-265-7802 |
|
|
|
|
| More on Medicare Basics. |
| |
| Still have questions? |
| |
|
|
| Medicare reimbursements for Power equipment. |
| |
