Medicare Claims | Filing Medicare | Medicare Billing | Non-Assigned | Assigned | Medicare Reimbursement information

This page is intended to share some of the questions we receive regarding what is covered by Medicare and various reimbursement methods. Use the links to the left of this page for further information regarding Medicare.

Important News on filing Medicare claims after
July 1, 2008:
Beginning July 1, 2008 customers purchasing equipment will not be able to file a Medicare non-assigned claim. Consumers/Medicare Patients will no longer be allowed to file claims themselves. If you want to pursue Medicare reimbursement for durable medical equipment you are forced to visit a local store participating in the new National Competitive Bidding (NCB). As a result, PHC will file Medicare claims (non-assignment) for Lift Chairs only. All other products require a visit to a local supplier.

Medicare is the federal health insurance program for people age 65 or older. It also covers certain younger people with disabilities and people with End-Stage Renal Disease. Medicaid is not the same as Medicare. Medicaid is a joint federal and state program that helps with medical costs for some people with low incomes and limited resources. Coverage varies from state to state. A person may have both Medicaid and Medicare. We do file Medicare claims, but we do not file Medicaid.

Knowing about deductibles, coinsurance, and co-payments also can help you understand Medicare Billing.

	The deductible is the amount that a person must pay for health care before Medicare Part A or Part B begins to pay. These amounts can change every year.
	Coinsurance is the percentage (usually 20%) of the Medicare approved amount that the person has to pay after paying the deductible for Part A and Part B.
	A co-payment is a set amount the person pays for each medical service, like a doctor visit. Medicare + Choice plans might also require co-payment.

We file Medicare claims for Internet sales on a non-assignment basis, for Lift Chairs only. Non-Assignment means that you pay for the product up-front. We complete 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.

Why do you need this product? The most common question we receive is "why won't Medicare cover the cost of what I need to perform my daily routine?" Medicare's coverage is limited to products required to help you get around your residence. They don't cover products for you to go to the mall, doctor's office, or to visit a neighbor.

Use common sense. Medicare will not cover a product just because your doctor wrote you a prescription. A prescription is just the first step of a series of criteria for Medicare eligibility.

Be practical. Medicare does not pay for luxury items when a basic product will work. The equipment you receive depends on the Medicare coverage criteria you meet.

Flexibility. In most cases Medicare has some simple "rules" for reimbursement and qualifications. Please don't try to "read-in" your own exceptions to these Medicare rules. They are what they are. Products are approved only when the patient cannot function without it, not necessarily when the product would make the patient's life easier or more comfortable.

I need a Denial from Medicare for my Insurance. Please don't ask a supplier to submit a claim so you can receive a denial from Medicare. If you need a denial for your insurance company, get educated and do it yourself. A supplier that submits a claim for which they know has no basis is simply filing a fraudulent claim and doing so repeatedly simply throws up a red flag at Medicare.

Co-Payments. Medicare has set reimbursement amounts for products. They reimburse 80% of that amount. Your insurance may or may not pay the remaining 20% of that reimbursement amount. You are responsible for the remainder if any. Only under special circumstances can the supplier "write-off" any remaining cost due to a hardship situation. Dealers or suppliers that tell you that there is no out-of-pocket are bordering fraud - it's illegal to tell you that. The ethics of an individual or company advertising or claiming to get you in a Power Wheelchair or Scooter with "no cost to you" as their main sales campaign should be questioned. Those are the tactics of unscrupulous individuals abusing the Medicare System. That's why the Medicare system is so tuff today and hesitant to shell out cash each time a dealer/supplier submits a claim for a product.

Capped Rentals. Some products are "capped rentals." Manual wheelchairs, beds, and Hoyer Lifts are good examples. Medicare pays the monthly rental of these items for a predefined term, it's not a purchase. When the rental period has expired you may have an option to purchase the product or continue paying the monthly rental yourself. In the situation of a rental, Medicare pays 80%, you are responsible for the remainder.

Claims. We file Medicare claims as a courtesy to our Internet customers. We process the claims in a timely manner. Sometimes there are delays in various stages of the processing cycle. Most are caused by the physician's failure to return a CMN form, or failure to read the instructions. Missing diagnosis codes, signatures, and incorrect answers to questions on the form are usually to blame for slow reimbursement. Many times we make several attempts to obtain missing forms back from the doctor.

Contact Medicare If you have questions regarding coverage and requirements, call Medicare at 800-MEDICARE. Medicare also maintains a website: www.medicare.gov. Be an educated consumer. Don't just simply rely on what someone else told you. Find out how the system works for yourself.