Medicare Questions And Answers

Important Medicare information

Most of the products need to go to the local MDE Supply so as to bill Medicare for the product that you want to rent or purchase. A lot of products which include the hospital beds, the respiratory products as well as some power wheelchairs are just covered as a month to month rental. The recent Medicare rates cover an average refund of 45% over the product categories. According to the refund amount which is now offered by Medicare, the supplies offer an economy product that matches the amount that Medicare will reimburse. When shopping for a specific product by brand or version name is limited to what your local supplier offers.

You have to visit a local Medicare supplier/store for Medicare coverage or for refunds for eligible items. Medicare claims have to be electronically submitted by your local supplier. Currently most of the time Medicare will reject paper billing from a beneficiary if the product will be purchased via the internet.

Read along as we are going to offer you the best links to Medicare’s pages for getting a product as well as a supplier within your area that will be capable of billing your Medicare. But keep in mind that some of the designated suppliers within our area might be around 2000 miles away. The supplies might carry/stock what is known as the economy products for Medicare billing.

Getting a Medicare supplier within your area

In order to access the Medicare Supplier, you will have to go to our Directory, enter your zip code then press enter, then choose the checkbox that is next to the category that you want, then press the search which is located below the page.

Medicare frequent asked questions and answers

  • The assigned and non-assigned claims: The assigned means that there is no out of pocket expenditures while the non-assigned means that you have to make up-front payments that will be refunded back to you.
  • Capped rental: This means there is paid as a monthly rental and there is no reimbursable purchase.
  • The compression hose: Currently there is no compression hose that is covered by the Medicare program.
  • The diabetic shoes and inserts: for the Medicare to cover the Diabetic shoes they have to be fit to your feet and this should be done by the local specialist. Medicare does not allow billing for the shoes that are sold over the internet.
  • The hospital beds and the adjustable beds: The hospital beds are normally capped rentals, while the adjustable beds are normally not covered. You will have to recheck with your local store.
  • The lift chairs: This covers about a $280 refund (reimbursement). This is filed as a non-assigned claim, and this means that it will require you to pay for an up-front. Contact your local store in case you need your Medicare to cover for the lift chair.
  • The patients lift: the patients are normally capped-rentals equipment. Contact your local store for more information regarding rentals.
  • The manual  Medical wheelchairs: These are also capped rental. All the manual chairs are covered by Medicare in a rental category. You have to contact your local store in case you need your Medicare to cover a manual wheelchair.
  • The oxygen concentrators, CAP, and the Nebulizers: This fall under the capped rental category of equipment. For equipment such as the CPAP, Nebulizer, concentrators as well as those related to this category are all covered as capped rentals. You have to visit your local store/supplier who is approved by Medicare so as to bill for Medicare.
  • The power wheelchairs: These are currently capped rental. You have to visit your local supplier/store that is approved by Medicare so as to bill for a power wheelchair in case you need one.
  • The power scooters are commonly known as the POVs: these are also capped rentals too. You have to visit your local supplier/store so as to bill for a power wheelchair in case you need one. You cannot purchase one via the internet.
  • The walkers and rollers: these have to be billed form the local supplier as Medicare will not cover one of purchased via the internet.

Obtaining  the Medicare coverage

Q: How can I get coverage for a medical item that I need for home use?

A: Under normal condition, the doctor will offer a written prescription and this is what is needed, or you can be offered a dispensing order that is written by your physician who is responsible for treating you. Some of the items need a well detailed written order before they are delivered or they need a Certificate of Medical necessity (CMN).

The dispensing order involves the following:

  • A detailed description of the item
  • The name of the beneficiary
  • The date of the order as well the physician’s signature and date

A written order should include the following:

  • A well-detailed description of the item as well as the accessories
  • The full name of the beneficiary
  • An ICD-9 diagnosis code
  • The order start date
  • The time interval of the need
  • The physician’s signature as well as the date

The Medicare assignment and the non-assignment billing

Q: What is the meaning of assigned and non-assigned?

A: The assigned means that Medicare will allow the approved fee for the equipment. Medicare will pay the supplier 80% of the entire approved fee. Secondary insurance normally covers the remaining 205 that is not covered by Medicare. If the beneficiary does not have a secondary insurance, then he/she will be responsible for covering the remaining 20%. The non-assigned means that the beneficiary has to pay upfront for the equipment and the supply will the file for the claim to the Medicare. If the claim is valid, then Medicare will refund the beneficiary by 80% of the approved fee that was paid.

Which equipment is covered by Medicare?

Q: What does Medicare cover?

A: Medicare Plan B covers durable medical items which include:

  • The manual wheelchairs which are categorized as capped rental
  • The power wheelchairs that are capped as capped rental
  • Some of the positioning items
  • The rollators as well as walkers
  • Scooters
  • The mattress over-lays which are capped rental
  • The sea-lift mechanisms for the lift chairs
  • The artificial limbs
  • The oxygen devices that are capped rental
  • The patient lifts that are capped rental
  • The orthodox and splints

in case you need Medicare coverage of one of the above-mentioned types of products, you will have to visit your local dealer that rents/sell the devices as well as bills the Medicare. A lot of people are surprised to know that the manual wheelchairs as well as hospital beds to be under capped rental items. These capped rental items require the dealer to maintain the item over the rental period of 13 months. You have to contact or visit your local supplier so as to get these items.

The durable medical items are covered by Medicare only if they are prescribed by the doctor and comply with the coverage criteria. You will have to find out the equipment that is covered and if the supplier is approved. You can do this by just calling the Medicare’s durable medical equipment regional carrier within your area.

Types of products that are not covered by the Medicare

Q: What items are not covered by Medicare?

A: The items which are not covered by the Medicare includes: the adaptive daily living support such as the automobile lifts, ramps, the reachers, the sock aids, utensils, shower chairs, the transfer benches, raised toilet seats, pulse oximeter, gab bars, and adjustable based beds. Normally the Medicare coverage does not go beyond the bathroom door.

Medicare coverage in the nursing home

Q: What does Medicare cover in the nursing home or in a skilled nursing facility?

A: under Medicare Part A the durable and orthotics medical items are not covered by Medicare. Under Part B, orthotics is covered. In case you are almost being discharged from a nursing home or a skilled nursing facility, the medical equipment will be delivered within two days before you are discharged so as to enable the staff as well as family to learn on the proper use of the equipment.

The Medicare home coverage

Q: What does Medicare consider as a home?

A: Home Medical equipment should be ideal to be used in the home. A home is your house, apartment, assisted living facility, a group of in which you live, a relative’s home. Some of the facilities are not considered as homes which include a skilled nursing facility, a hospital or a nursing facility.

The capped rental

Q: What is the meaning of capped rental?

A: For most of the items that fall under Medicare coverage 80% of the rental cost is covered for 13 months of use. Normally the secondary insurance covers the remaining 20%. The following are the products that are covered as a capped rental:

  • The respiratory items such as the oxygen concentrators
  • The power wheels
  • The patient lifts
  • The manual wheelchairs
  • The aid surfaces such as the Low-Air –Loss
  • Alternating pressure and the rotational mattresses

When Medicare finishes paying for the 13 months use, the supplier is able to transfer the title of ownership to the beneficiary.

Some of the respiratory items are rent for long periods of time. The oxygen concentrator rentals can be covered for up to 36 months.

The Medicare coverage of manual wheelchair

Q: Does Medicare cover manual wheelchairs?

A: Under normal conditions, the manual wheelchairs are normally covered by Medicare as a Capped Rental. This implies that Medicare will pay about 80% of the monthly rental cost and the beneficiary will be responsible for paying the remaining 20%. In case the beneficiary has secondary insurance, the remaining 20% will be covered by the insurance. You can use your local supplier that offers rental services for chairs and he/she will help you in billing for Medicare monthly rental fees. Some of the Ultra-lightweight wheelchairs consist of a K0005 billing code and can be billed like a purchase.

The rollator and walker coverage

Q: Does Medicare cover the rollator and walker?

A: Medicare allows the rollator and walker in every 5 years. Medicare will cover 80% of the entire allowed fee approved by Medicare. If you have secondary insurance that covers the remaining 20%, the reimbursement is almost$125 no matter if your rollator cost $150 or $350, the reimbursement amount is normally fixed, unless you qualify heavy duty or for a bariatric walker. Rollators are normally coded as the walkers which have the ideal accessories such as the seat, hand brakes, wheels. You will have to visit your local Medicare in case you need help with rollators as well as walkers.

The doctor prescription

Q: What does the doctor have to prescribe let’s say you need a rollator?

A: You need a walker with 4 wheels, a seat as well as handbrakes.

The adjustable bed Medicare coverage

Q: Does Medicare pay or reimburse when it comes to adjustable beds?

A: The Medicare coverage for beds is limited just limited to a semi-electric hospital bed and the entire hospital beds are covered as a capped rental. Adjustable beds are not covered by Medicare.
Medicare Coverage for hospital beds

Q: Does Medicare pay or reimburse when it comes to hospital beds?

A: Hospital beds fall under the capped rental category within Medicare coverage. This implies that a local vendor who rents the equipment should be used and is responsible for filing the billing for the monthly fees. Your local dealer is responsible for installing and maintaining this capped rental equipment. Medicare does not consider some of the equipment such as the full-electric hospital bed, and other luxury beds to be a medical necessity. The Medicare coverage is only meant for a semi-electric twin size hospital bed.

The Overbed tables

Q: Does Medicare cover the overbed or the bedside tables?

A: The overbed tables, as well as the bedside tables, are not categorized as a medical necessity and Medicare does not cover them.

The respiratory items coverage

Q: Does Medicare cover CPAP, Oxygen Concentrators, and Nebulizers?

A: Yes, these and respiratory products are considered as capped rental via Medicare.

Q: In case I purchase a portable oxygen concentrator will Medicare refund me?

 A: No, Medicare does not accept for or offer coverage of home oxygen concentrators as well as additional portable concentrators. In case you need one of these items you will have to seek a local vendor who rents them and bills Medicare.

The transfer boards

Q: Does Medicare cover for transfer boards?

A: The transfer boards are considered among the medical necessity equipment for the patients that have a medical condition that limit their ability to move from their wheelchair to bed, or toilet. In case you are looking for Medicare coverage for these items you have to visit your local vendor.

The patient lift coverage

Q: Does Medicare Patient lifts?

A: The patient lifts fall under the capped rental equipment category. This implies that the supplier that rents the equipment has to file the bill to Medicare for the monthly fees. Medicare will reimburse 80% of the rental for a period of 13 months. This coverage is only for the standard hydraulic manual lift as well as a sling. The power lifts, as well as the standing lifts, are not covered by the Medicare coverage.

Q: Does Medicare cover stand-up lifts?

A: No, this coverage is just for the manual/hydraulic patient lift. You can visit the local vendor to rent a patient lift.

The power wheelchair Medicare coverage

Q: What criteria does Medicare consider for a power wheelchair coverage?

A: Medicare normally does not pay the entire fees but only a part of the entire fee when it comes to a motorized wheelchair. A power wheelchair is normally covered when the following conditions are met:

  • The patient is in such a condition such that without using a motorized wheelchair the patient is confined to be or chair.
  • The patient’s condition makes a wheelchair a necessity to the patient as the patient cannot operate a manual wheelchair.
  • The patient is able to safely operate and control a power wheelchair.

A patient who is regarded as to be in need of a wheelchair is normally in a state where he/she cannot walk and is experiencing severe weakness in the upper extremities due to neurological or muscular conditions or disease. In case the documentation does not offer the medical necessity of a need of a power wheelchair but support the necessity of a manual wheelchair, then the payment will be based upon the least costly medically appropriate alternative. But in case the power wheelchair has been purchased while the manual wheelchair upon which the payment is based is within the capped rental category, then the power wheelchair will be rejected as being a medical necessity. Options that are referred to as to allow beneficiaries to perform leisure or recreational activities are not covered by Medicare.

The power scooter Medicare coverage

Q: What is the Medicare coverage when it comes to power-operated vehicles as well as scooters?

A: Medicare covers the power-operated vehicle when it full fills the following criteria:

  • The patient’s condition does not allow him/her to operate a manual chair.
  • The patient has able to safely operate the wheelchair for the POV.
  • The patient is capable of transferring in and out of the POV and has enough trunk stability to be able to safely ride and control the POV.

Normally the POVs are ordered for the patients who are capable of moving around within their home but need a power wheelchair when they need to move outdoor. POVs will be rejected as they do not comply with being a medical necessity under such conditions.

The POV which is beneficial in primarily enabling the patient to do leisure or recreational activities will be rejected as being a medical necessity. In case Medicare covers a mobility scooter then a wheelchair that is offered at the same time or subsequently is normally as not being a medical necessity.

Medicare and the lift coverage

Q: Does Medicare cover for a lift chair?

A: In order to have the Medicare coverage of these items you have to visit a local vendor. Just the seat lift mechanism that is installed in a lift chair is what might be regarded as a medical necessity in case the following criteria are met:

The patient should be suffering from severe arthritis of the knee or hip and must have a severe neuromuscular disease.

  • The seat lift mechanism should be a part of the physician’s means of treatment and can be prescribed as being a necessity in improving the patient’s condition, or it has to be arresting or retarding the deterioration of the patient’s condition.
  • The patient must be entirely incapable of standing up using a normal armchair or any other chair that is found in their home. The patient is incapable of getting up from the chair, especially the low chair, which is not sufficient to justify that you need to have a seat lift mechanism. As almost all the patients who are capable of walking are capable of getting out of the normal chair if the seat height is set at an appropriate angle as well as the arms.
  • And once the patient stands up he/she will be able to walk.

Medicare coverage of the seat lift mechanism is limited to a few types that can be smoothly operated and controlled by the patient. Besides, it should effectively be able to assist the patient when the patient needs to stand up or sit down without a need for any other assistance. Medicare coverage is limited to the seat lift mechanism no matter if it is installed within the chair. Medicare reimbursement ranges between $275.
Medicare and Diabetic shoes

Q: Are diabetic shoes covered by Medicare?

A: Medicare does not reimburse for or allow the coverage of Diabetic shoes, in case the shoes are fitted upon your feet by a local Pedorthist or a trained filter. Generally, in most cases, the process involves heat molding the shoe or inserting it to your foot so as the foot conditions to be properly treated. Even when using this personal fitting the must be prescribed by a licensed physician who treats the foot condition that is resulting from Diabetes. Besides the person who is fitting and offering the shoes has to be approved by Medicare and should be a Medicare provider so as to be able to bill for the device. Medicare will pay for a single pair of shoes and 3 pairs of inserts annually. The patients who are looking for Medicare coverage of shoes are normally diagnosed with peripheral neuropathy.

Medicare Co-payments

Q: Will I have to pay a 20% co-payment to Medicare?

A: When you have met your deductible you are required to pay directly or via supplemental insurance, the remaining 20% of the Medicare-approved amount. This co-payment might not be dropped by the vendor unless in hardship conditions and only depending on the case at hand. A vendor who regularly drops the co-payment might be violating federal law.

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