Medicare Documentation Guidelines For Hospital Bed
In order for Medicare to provide coverage for renting or buying a hospital bed, there must be formal documentation showing that it is a medical necessity for the individual.
A prescription from a physician who participates in Medicare is needed. There must be notes in your medical records that show, from at least one face-to-face encounter with the doctor, that one of the medical requirements is present in the patient. This is the proof that Medicare needs to know that the hospital bed is medically required.
This prescription for a hospital bed must clearly state the patients name, the hospital bed, the diagnosis that creates the medical requirement for the hospital bed, and how long the bed will be needed.
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Will Medicare Cover Any Upgrades
Original Medicare will cover things like digital pacemakers, wheelchairs, and diabetic strips as they are medical necessities. When it comes to Medicare coverage, only the basics are covered. This means that when it comes to the equipment that is covered, Medicare will only cover the costs for the basic version of it. If one requires or desires an upgraded version, they will have to cover the upgrade price difference themselves.
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Medicare Approved Hospital Bed Suppliers
Hospital bed suppliers are also often known as DME suppliers. In order to receive financial assistance with the purchase or rental of a hospital bed, the supplier must participate in Medicare, and they must accept assignment. Medicare assigns a cap on how much a piece of equipment, such as a hospital bed, can cost the supplier must accept this Medicare assignment.
Medicare Competitive Bidding Program
Under Medicare’s Competitive Bidding Program, DME suppliers submit bids to provide equipment to Medicare recipients living in or visiting competitive bidding areas. If you have Original Medicare and live in or are visiting a state in a competitive bidding area, you must get your DME from a contract supplier.
Refer to Medicare.gov to find out if you live in a competitive bidding area.
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Are Hospital Beds Covered By Other Medicare Parts
Similar to how Medicare Part B provides coverage for at-home hospital beds, there are other plans that also provide assistance for anyone that needs a bed. For example, Medicare Advantage, or Medicare Part C, sells bundle plans from private insurance companies, which includes both Medicare Part A and Part B.
The basic costs required for DME will be covered in addition to other costs that could benefit you. For one thing, not only is the patient receiving inpatient hospital care through Part A, but theyre also benefiting from DME coverage. Similarly, the added benefits that a Medicare Advantage plan could offer you include dental, hearing, and prescription drug coverage.
Before deciding on a plan, we recommend that comparing the rates between a standalone Medicare Part B plan and a Medicare Advantage plan. Make sure to pick the one that benefits you the most in regard to hospital bed coverage.
Variable Height Hospital Bed
Variable height beds are another type of manual bed, which has the added option of adjustable height, so as well as being able to adjust the head and foot sections of the bed, you can change the overall bed height.
The adjustments are made using a hand crank.
The variable height bed is often used for individuals who need to get very low to the floor, and for those who risk falling from the bed, where the best solution for this is to lower the bed as close to the floor as possible while they are sleeping.
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Buying The Ideal Hospital Bed Frame
Purchasing a hospital bed for private use starts with choosing the right bed frame. Seniors, patients, and their families can choose from basic selections to luxury models, taking into account what the person using the bed needs for adjustable functionality, comfort, and assistance.
Theres a stereotype about hospital beds being large, cumbersome, and hard to use. That isnt true! Every model on the market is an electric bed, meaning it uses a power source to let the patient raise and lower the height, adjust the position of the mattress, and use accessories that add comfort and stability.
Features like this make it easier to get into walkers or wheelchairs independently or without added pain and discomfort. For those at risk of falling, have mobility or balance issues, require more positioning options, cannot sleep on flat mattresses, or receive care where a higher bed height and bed re-positioning is important, hospital beds are easy to adjust.
How Do I Qualify For A Hospital Bed
To qualify for a hospital bed you must show that you:
- Change positions in ways not possible on a normal bed
- Lay or sleep in positions not possible with a normal bed in order to relieve pain
- Have to sleep with the head of the bed higher than 30 degrees because of conditions such as congestive heart failure, breathing problems, or other types of problems
- Use traction equipment that must be attached to a hospital bed
- Have a Certificate of Medical Necessity that is completed, signed and dated by the treating doctor
The above is the basic criteria for coverage for hospital beds. There are a number of different kinds of beds, such as an adjustable hospital bed. Each will have additional requirements for coverage. Your treating doctor and/or your supplier will know what needs to be documented in order for you to qualify for the bed and equipment that is right for you. Adjustable beds, full-electric beds and electric hi-lo beds are considered convenience devices, and are not covered by Medicare.
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Important Shopping Considerations For Home Hospital Beds
Home hospital beds provide caregivers with the ability to care for patients and loved ones at home. However, these beds are an expensive purchase. As such, youll want reassurance that youre buying the best one for your needs.
Review the following FAQ so you can make an informed purchase.
What are the benefits of a hospital bed?
When a person is recovering from an illness or injury, or if theyre living with a chronic long-term condition, a hospital bed is better suited to serve their needs than a traditional bed. A person using a hospital bed will be spending significantly more time in the bed, both during the day at night.
The adjustments available with a hospital bed support various physical conditions, and at different times of day. During the day, the head can be elevated to allow the person to sit up comfortably, while the knee or foot area can also be elevated to aid therapeutic goals.
Hospital beds also make it easier for caregivers to take care of the patient, since the height is adjustable as well. The bed can be lowered to help the person get out of bed, or highered so the caregiver doesnt have to bend down to take care of them.
What are the top hospital bed manufacturers?
How much does it cost to buy a hospital bed?
Hospital beds are sophisticated devices that support individuals with varying medical needs. Depending on the brand and the type of bed, as well as whether its sold as a package , a hospital bed may range from $500 to a few thousand dollars.
Which Types Of Beds Or Mattresses Are Covered By Medicare
Certain beds and mattresses, along with other sleep accessories, do qualify as durable medical equipment. But only some types of beds and mattresses will be able to meet the requirements necessary to be covered by Medicare.
There are three types of beds and bed-related equipment that are covered by Medicare:
Coverage for each of these types of beds or mattresses varies depending on the specifics of your Medicare plan. It also depends on the type of equipment your doctor prescribes and your diagnosis.
Depending on what your doctor prescribes for you, Medicare may require you to rent or buy the bed or mattress you need. Some Medicare subscribers may be able to choose which is best for them. Additionally, youll need to order your bed or mattress from a DME subscriber whos enrolled in Medicare. If you dont, Medicare wont pay your claim.
Make sure you check with both your doctor and any mattress or bed company to ensure everything is accepted through Medicare. Thats the best way to ensure youre getting the Medicare coverage and financial assistance you need.
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What Makes Hospital Bed Mattresses Unique
As essential as the proper bed frame is the hospital mattress. Regular mattresses do not work with adjustable or hospital beds the mattress must contour to the positions the bed can take. While also giving more positional options to the patient, hospital mattresses are designed to redistribute pressure, decreasing the likelihood of bedsores and other ailments of lengthy bed rest. They provide both comfort and a firm foundation for the user, letting them relax while lying down and sit up on the side of the bed with ease.
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What Other Medical Equipment Are Covered By Medicaid
Aside from hospital beds, there is a lot of medical equipment being covered by Medicaid. Here is a table that will show you per category.
|DURABLE MEDICAL EQUIPMENT|
|Kidney devices, urological and ostomy supplies|
These are some of the durable medical equipment covered by Medicaid. You can check this site to see the full list of durable medical equipment and coverage policies of Medicaid.
Well, speaking of coverage policies, you must also know the coverage limitations for medical equipment since there are certain things you need to do, in order to make sure that Medicaid will cover or reimburse the fees for this medical equipment.
Can I Rent A Hospital Bed
For more expensive equipment, such as a hospital bed, Medicare pays a rental fee for 13 months of a persons continuous use. After the 13th month, the supplier transfers ownership of the bed to the individual. If the bed needs repairs or replacement parts during the rental period, the supplier assumes responsibility for the costs.
A person who needs less expensive DMEs can choose to rent or buy the equipment.
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What Qualifies A Patient For A Hospital Bed
Hospital Beds The patient has a medical condition which requires positioning of the body in ways not feasible with an ordinary bed . The patient requires the head of the bed to be elevated more than 30 degrees most of the time due to congestive heart failure, chronic pulmonary disease, or problems with aspiration.
How Much Does It Cost To Rent Or Buy A Hospital Bed
After you have paid your annual deductible, you will pay 20% of the Medicare-approved amount for the hospital bed purchase or rental and maintenance. If you have Supplemental insurance you may have little to no out-of-pocket cost for a manual crank, or a semi-electric Hospital bed.Those costs may be higher if the supplier doesn’t accept assignment. Hospital beds are in the Capped Rental category, which means you may choose to rent or purchase the bed. Once Medicare has made 10 monthly rental payments you will be given an opportunity to purchase the bed. The supplier will send you a “Purchase Option” letter in the ninth month of the rental. You will have 30 days to reply.If you reply and want to buy the bed:
- Medicare will make three more payments and the bed is yours.
- You will be responsible for maintenance .
If you do not answer or choose to continue renting:
- Medicare will make a total of 15 rental payments and the bed is yours to use as long as you need it.
- The supplier keeps ownership of the bed and is responsible for maintaining it.
- You may be charged a maintenance and service fee every six months.
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Do Private Medicare Plans Cover Hospital Beds
There are two types of private Medicare insurance plans that may be able to help with the cost of a hospital bed.
- Medicare Advantage plans are required by law to cover all of the same basic services and items that Medicare Part A and Part B cover, so all of the above coverage details will remain in effect. Many Medicare Advantage plans may then offer some additional coverage for things that Part A and Part B dont cover, and some Medicare Advantage plans may provide more coverage of hospital beds or have different deductibles or coinsurance requirements than Parts A and B.
- Medicare Supplement Insurance plans help pay for some of the deductibles, copayments and coinsurance found in Medicare Part A and Part B. These plans can pick up the cost of some of the Medicare cost-sharing requirements for both inpatient and outpatient hospital beds. You can compare Medicare Supplement plans online for free, with no obligation to enroll.
Its important to note that Medicare Advantage plans and Medicare Supplement plans are very different, and you cannot have both types of plans at the same time.
Which Medicare Plans May Be Best For You If You Know You Need A Hospital Bed At Home
You can get coverage for hospital beds through a few different parts of Medicare.
If you use Medicare parts A and B, together called original Medicare, your coverage will be through Medicare Part B. Thats because Medicare Part A covers inpatient stays and care you receive in hospitals and skilled nursing facilities.
- emergency room care
- medical equipment
Part B will cover 80 percent of the Medicare-approved amount of your hospital bed. Youll pay the remaining 20 percent.
You can also get coverage through a Medicare Part C plan. Part C plans, also known as Medicare Advantage plans, are offered by private companies that contract with Medicare.
Theyre required to provide the same coverage as original Medicare. Plus, many Advantage plans go beyond the coverage of original Medicare to offer additional covered services.
So, since original Medicare covers hospital beds, all Advantage plans will also cover hospital beds. Your cost might be more or less than with original Medicare, depending on your plan.
Medicare Part D is prescription drug coverage. It wont help you pay for any DME, including hospital beds.
Medigap, however, can help you pay for a hospital bed. This is Medicare supplement insurance. It covers some of the out-of-pocket costs of using original Medicare, like copayments and coinsurance amounts.
So, if you use Medicare Part B to get a hospital bed, a Medigap plan could cover the 20 percent coinsurance amount youd normally need to pay.
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Renting Home Hospital Beds
Renting a home hospital bed is a great option for those who will only need it for a limited period of time. This is a much more cost efficient option for short-term use. On average, it costs one $200 $500 / month to rent a home hospital bed. One can also find mattresses for rent. Some companies that rent home hospital beds may charge an initial fee for set-up. If this is the case, one should expect to pay an additional $50 to $100.
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What Factors Can Affect Dme Costs
A key factor affecting DME cost is whether a supplier participates in Medicare.
A participating supplier is one that accepts assignment, which means the company can charge a person only the coinsurance and deductible for the Medicare-approved amount.
However, if a company is not a participating supplier, there is no limit to what it can charge.
Other factors affecting the cost include whether an individual has other insurance and whether a person buys or rents the equipment.
This online search tool can help people search for a DME supplier in their area.
As an alternative, a person can call 800-MEDICARE . A person who is deaf may call 877-486-2048.
Questions to ask a supplier may include:
- Do you accept Medicare assignment? In not, what is your non-assignment charge?
- Are you a Medicare-enrolled supplier?
- Do you bill Medicare directly?
Your Costs Under Medicare
If you meet eligibility criteria for a home hospital bed, Medicare will pay 80 percent of the cost. You will have to pay 20 percent of the Medicare-approved cost after you pay your Medicare Part B deductible.
A Medigap Medicare Supplement insurance policy may help pay for some of your out-of-pocket costs. Check with your Medigap plans administrator for complete details.
A Medicare Advantage plan is required to cover everything Original Medicare Medicare Part A and Part B covers. But it may cover more of the cost than Medicare Part B.
Coverage varies from plan to plan, so you should check with your Medicare Advantage plan administrator to determine your coverage. You should also make sure that your plan will cover a bed from your supplier.