Medicare FAQGeneral Medicare questions answered. Medicare Competitive Bidding ProgramWith Medicare's "Competitive Bidding Program" you must shop locally for any product to be billed to Medicare. Everything is based on the patients zip code. You must find a local supplier in order to bill Medicare. The new Medicare rates, amount to an average reimbursement cut of 45% across affected product categories. In response to the reimbursement amount now offered from Medicare, suppliers provide an "economy product" to match what Medicare will reimburse. Shopping for a particular product by brand or model name is restricted to what your local supplier stocks and offers.We do not Bill Medicare: Visit a local Medicare Provider/Store for Medicare coverage or reimbursement for an eligible products. Medicare claims must be submitted electronically by your local supplier. Medicare may no longer accept (paper) billing from a beneficiary when a product is purchased over the Internet. We'll provide you with (what we believe are) the best links to Medicare's pages for finding a product and a supplier in your area capable of billing Medicare. Some designated suppliers for your area may be 2000 miles away! Suppliers may only carry/stock what they call "economy" products for Medicare billing. *** Find a Medicare Supplier in your area: Medicare Supplier Directory (Opens in new window) Enter your Zip Code, press Go, check the product category you're interested in, then press "Search" at the bottom of the page. Beneficiary Complaint Hotline: *** Phone number for beneficiary complaints: (800) 404-8702 The phone number above is to live operators and is staffed 24/7. Use this number if you are unhappy with the lack of service and quality equipment you receive resulting from the Medicare bidding policy. Questions for Medicare: Medicare phone number: 1-800-MEDICARE (1-800-633-4227), (TTY users: 1-800-486-2048) Use this link to look-up a supplier in your postal zip area: Medicare Supplier Directory Medicare FAQ Quick answers to frequently asked Medicare questions
ANSWER: In most cases a Doctor's written prescription (Rx) is all that is required, or Dispensing Order written by the treating physician. Some items require a Detailed Written Order (DWO) prior to delivery or a Certificate of Medical Necessity (CMN). You can view or Download Medicare Forms here. A Dispensing Order (prescription) must include:
Medicare Assignment and Non-Assignment Billing QUESTION: What does "assigned" and "non-assigned" mean? ANSWER: "Assigned" means the supplier accepts the Medicare-approved fee for the equipment. Medicare pays the supplier 80% of the approved fee. Secondary insurance usually picks up the 20% Medicare doesn't cover. The beneficiary is responsible for the remaining 20%. "Non-assigned" means the beneficiary pays the supplier in full for the equipment and the supplier submits the claim to Medicare. If the item is covered, Medicare reimburses the beneficiary 80% of the approved fee. Which products are covered by Medicare QUESTION: What is Covered by Medicare? ANSWER: Medicare Part B helps pay for durable medical equipment, including;
If you want Medicare coverage on one of the product types listed above visit a local dealer that sells/rents equipment and bills Medicare. Many people are surprised that Manual Wheelchairs and Hospital Beds fall under "capped rental" items. For these "capped rental" items, the dealer (provider) is required to maintain the equipment over the lease period (13 months). You must visit a local dealer for these products.
Durable medical equipment, such as wheelchairs, are covered only when prescribed by a doctor and the coverage criteria is met. You can find out what equipment is covered, and whether a supplier is approved, by calling Medicare's durable medical equipment (DMERC) regional carrier for your area.
Products Not Covered by Medicare QUESTION: What is NOT covered by Medicare? ANSWER: Equipment not covered by Medicare includes; adaptive daily living aids such as: ramps, automobile lifts, reachers, sock-aids, utensils, transfer benches, shower chairs, raised toilet seats, adjustable based beds , pulse oximeter and grab bars. Basically, Medicare stops at the bathroom door. For more detailed information regarding coverage, call 1-800-MEDICARE. QUESTION: What is covered in a nursing home or skilled nursing facility?
ANSWER:
Under Part A, orthotics and durable medical equipment are not covered. Under Part B, only orthotics can be covered. If you are about to be discharged from a nursing home or skilled nursing facility, medical equipment can be delivered two days prior to discharge to allow the staff and family to learn how to use the equipment.
Coverage for your Home QUESTION: What is considered, Home? ANSWER: Home medical equipment must be appropriate for use in the home. Your "home" is your house, assisted living facility, apartment, a relative's home, or a group home in which you live. However, certain facility's are NOT CONSIDERED YOUR HOME: a hospital, skilled nursing facility, or nursing facility. Capped Rental
QUESTION: What does capped rental mean?
ANSWER: For the majority of products covered by Medicare, 80% of the rental is covered for 13 continuous months of use. Most secondary insurers pick up the remaining 20%.
Products covered as capped rental:
After Medicare has paid for 13 months of continuous use, the supplier may transfer the title to the beneficiary. Respiratory Products: Some Respiratory products have longer rental periods. Oxygen Concentrator (Medicare) rentals may be covered for up to 36 months. Medicare Coverage of Manual Wheelchair QUESTION: Are manual wheelchairs covered by Medicare? ANSWER: In almost all cases, manual wheelchairs are covered by Medicare as a "Capped Rental." This means that Medicare pays approx. 80% of the monthly rental and you are responsible for the remaining 20% or this may be covered by secondary insurance. You must use a local dealer that rents chairs and bills Medicare for the monthly rental fees. Some Ultra-lightweight wheelchairs have a K0005 Billing code and can be billed as a purchase. All manual wheelchairs on our website are for purchase only. Medicare does not reimburse for the purchase of a wheelchair. See all manual wheelchairs Rollator & Walker Coverage QUESTION: Are Walkers and Rollators covered? ANSWER: Medicare will allow a Walker or Rollator every 5 years. They cover 80% of the allowed amount set by Medicare. If you have a supplement insurance that covers the 20%, reimbursement is usually about $125.00. Regardless of whether your rollator cost $150 or $350, the reimbursement amount is basically the same, unless qualifying for heavy-duty or Bariatric walker. Rollators are coded as walkers with appropriate accessories (wheels, seat, hand brakes). Visit a local supplier that bills Medicare if you want Medicare assistance with walkers and rollators. QUESTION: What should the doctor's prescriptions say for a Rollator? ANSWER: Walker with 4 wheels, seat, and handbrakes. See all Walkers and Rollators Adjustable Bed Coverage QUESTION: Does Medicare pay or reimburse for Adjustable Beds? ANSWER: Medicare coverage for a bed is limited to a Semi-Electric Hospital Bed and all hospital beds are covered as a capped rental only. Medicare does not cover Adjustable Beds. See next FAQ answer for coverage details. See all Adjustable Beds Hospital Bed Coverage QUESTION: Does Medicare pay or reimburse for Hospital Beds? ANSWER: Medicare covers hospital beds as a Capped Rental item. This means that you must use a vendor in your local area that rents equipment and bills Medicare for the monthly fees. Your local dealer will install and maintain this "capped rental" equipment. Medicare does not consider a full-electric hospital bed, Adjustable Bed, or other Luxury beds to be medically necessary. Medicare coverage is for a Semi-electric twin-size hospital bed. See all Hospital Beds Overbed Tables QUESTION: Are Overbed or Bedside Tables covered by Medicare? ANSWER: Over-Bed Tables an Bedside Tables are not classified as a medical necessity and are not covered. See all Bedside Bed Tables Respiratory Equipment Coverage QUESTION: Are Oxygen Concentrators, CPAP and Nebulizers covered by Medicare? ANSWER: Oxygen Concentrators, CPAP and other respiratory products such as Nebulizers are Capped Rentals thru Medicare.
QUESTION: If you purchase a Portable Oxygen Concentrators will Medicare reimburse me?
See all Respiratory products. Transfer Boards QUESTION: Are Transfer Boards covered by Medicare? ANSWER: Transfer boards may be considered medically necessary for patients with medical conditions that limit their ability to transfer from wheelchair to bed, chair, or toilet. For Medicare coverage of these products visit a local supplier. See all Transfer Boards. Patient Lift Coverage QUESTION: Are Patient Lifts covered by Medicare? ANSWER: Patient Lifts are covered as a capped rental item. This means that you must visit a local supplier that rents such equipment and bills Medicare for the monthly fees. Medicare reimburses 80% of rental for up to 13 months. This capped-rental coverage is for a standard hydraulic-manual lift and sling. Power Lifts and Standing Lifts are not covered. For Medicare coverage of these products visit a local supplier. QUESTION: Are Stand-up Patient Lifts covered by Medicare? ANSWER: No. Patient Lift coverage is for a Manual/Hydraulic Patient Lift only. Visit a local supplier to rent a Patient Lift. Power Wheelchair Coverage QUESTION: What is Medicare's coverage criteria for motorized or power wheelchairs? ANSWER: Medicare may pay partial rental for a motorized wheelchair. A power wheelchair is covered when all of the following criteria are met:
See all Power Wheelchairs. Power Scooter Coverage QUESTION: What is Medicare's coverage of power operated Vehicles (POVs) or scooters? ANSWER: A power operated vehicle (POV) is covered when all of the following criteria are met:
See all Power Scooters Lift Chair Coverage QUESTION: Will Medicare pay for a Lift Chair? ANSWER: For Medicare coverage of these products visit a local supplier. Only the seat lift mechanism on a Lift Chair could be considered medically necessary if all of the following coverage criteria are met:
Diabetic Shoes QUESTION: Does Medicare cover the cost of Diabetic Shoes? ANSWER: Medicare does reimburse for, or authorize the coverage of Diabetic shoes, if the shoes are fitted to your feet by a local Pedorthist or trained fitter. Most cases involve "heat molding" the shoe or insert to your feet such that the foot condition is treated properly. Even with this personal fitting, the shoes must be prescribed by a qualified physician treating a foot condition resulting from Diabetes. In addition, the person fitting and providing the shoes must be approved by Medicare and must be a Medicare provider in order to properly bill for the product. Medicare will cover 1 pair of shoes and 3 pairs of inserts per calendar year. Patients seeking Medicare coverage of shoes are usually diagnosed with peripheral neuropathy.See all Diabetic Shoes and Footwear Ramps QUESTION: Does Medicare cover Wheelchair Lifts and Ramps? ANSWER: Medicare does not reimburse nor authorize the purchase of mobility lifts or ramps 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. See all Wheelchair and Scooter Ramps Medicare Co-payments QUESTION: Do I have to pay the 20% co-payment to Medicare? ANSWER: 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. A supplier who routinely drops the co-payment may be violating federal law. Got a question for us? Click here and email it to service@phc-online.com |