Medicare Claims |
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 | 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.
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| What kind of claims do we file for products on our website? |
| | Medicare | YES | | Medicaid | NO | | HMO's | NO | | Insurance | NO |
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| What products do we file Medicare claims for when purchased? |
| - Lift Chairs
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Walker and
Rollators
- Power Wheelchairs
- Power Scooters
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| 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.
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| What about Bath products? |
| - Bath products are not covered by Medicare.
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| 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.
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| 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.
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| 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
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| 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
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| 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.
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| 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.
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| Read PHC's Privacy Notice and HIPAA Compliance: |
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| 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.
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| The most common causes for delays in Medicare reimbursement. |
| - Doctor does not complete the required information on the CMN.
- Missing or inaccurate patient information.
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| How do you get the information to us? |
| - FAX or mail the information to us: 214-265-7817
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| Our mailing address: |
| PHC
attn: Medicare Processing
10362 Miller Rd
Dallas, TX 75238 | Medicare phone #: 214-265-7810 PHC Customer Service #: 214-265-7802 |
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| More on Medicare Basics. |
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| Still have questions? |
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