Thursday, July 18, 2024

How To Get Medical Equipment Through Medicare

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What Is Not Durable Medical Equipment

Medical Equipment Suppliers Feel Squeeze in New Medicare Bidding Process

Not every item an older adult needs for safety, mobility or therapy counts as durable medical equipment. Gauze bandages, for example, are disposable supplies.

Most gloves, sanitary pads and bed liners are also disposable, as are single-use items such as transdermal patches or lancets used for a single finger stick. Diabetes test strips are not considered DME, though the blood sugar monitor that reads them is. Eyeglasses are durable medical supplies, though most contact lenses are not.

Do Medicares Benefits Include Home / Durable Medical Equipment

The short answer is, Yes, Medicare does pay for Durable Medical Equipment ! However, before a thorough discussion of the details, it is important to be aware of the different types of Medicare coverage, as the benefits differ based on ones type of coverage. Medicare Part A is hospital insurance and Part B is for medical outpatient services. . Part C combines Part A and Part B and generally offers additional benefits, such as vision and dental. Part C is sold by private companies, rather than provided by the government. Medicare Part D is for prescription drugs and is not relevant to the discussion of DME.

Part A covers medical equipment for individuals who are in a skilled nursing facility or in the hospital. If the equipment is medically necessary and purchased from an approved supplier, Medicare Part A will pay for 80% of the allowable amount for any specific item. The individual or their supplemental insurance is responsible for paying for the remaining 20% and any amount over the allowable limit.

Part C, as mentioned before, is also known as Medicare Advantage. It is required by law to provide, at a minimum, the same coverage as Part A and Part B. Thus, if one has Medicare Part C, their plan will pay at least 80% of the allowable limit for durable medical equipment.

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How To Get A Medical Alert Bracelet For Free

Older Americans are living longer and more independent lives than previous generations. However, many of them live on a fixed income that comes primarily from Social Security, pension plans, and savings built throughout their life. A fixed income can make necessary medical expenses like medical alert systems costly to pay for out-of-pocket or in full. Despite the sometimes expensive cost, these devices are essential to maintaining older adultsâ health and well-being and can prevent significant medical bills from falls or other health emergencies.

Fortunately, there are often discounts for medical alert programs. While rare, there may even be situations where you can get a medical alert bracelet for free. These opportunities are not necessarily available to everyone and will depend on your situation and insurance coverage. This guide will help you find a free or discounted medical alert bracelet.

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Talk To A Senior Assistance Agency

If insurance, including Medicare and Medicaid, fall short in covering the costs associated with getting a medical alert bracelet, you may want to check in with local senior assistance agencies. These are typically locally-focused organizations that specialize in assisting seniors. Most of the assistance agencies receive state funding or are managed directly by the state. Their offerings will also vary depending on location. In some cases, these agencies can help you cover the cost of a medical alert bracelet. Check with Area Agencies on Aging for grants and other programs to help.

Portable Oxygen Concentrator Medicare Insurance

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Many Medicare beneficiaries who have needs for oxygen equipment, including POC, have always sought to know the government-controlled healthcare stance on oxygen tanks and concentrators. Some of the common questions asked have been in the following directions are there Medicare Supplement Plans with 100% Portable Oxygen Machine Coverage? If there are, is it on all Portable oxygen concentrators, or are there certain Prices of Portable Oxygen Concentrator Covered by Medicare? We will be answering all of these questions to clear the air on how far Medical care coverage goes and if they cover POCs.

Medicare beneficiaries have always had durable equipment such as wheelchairs covered by the health system, and this was also the case for medical oxygen tanks and concentrators. However, the whole game changed after the healthcare reimbursement rate was cut down by 50 percent in 2013. Medicare still funds the supply of oxygen equipment but only a part of it.

According to Medicare, there are specific criteria that must be satisfied by patients before they can be considered eligible for oxygen equipment, including POCs. If the requirements are met, they will help cover part of the cost. The conditions are outlined below:

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Who Qualifies For Free Used Medical Equipment

We have listed many, many different used medical equipment providers in this list. Each one sets their own standards for who qualifies for their items. Some agencies serve everyone, with no restrictions. Some have income guidelines, location guidelines or other criteria. Youll have to contact the agency to get more information about who qualifies for their program.

Does Medicaid Cover Durable Medical Equipment

Medicaid programs vary from state to state, which means that what Medicaid covers also varies by state. To find the most relevant information, we recommend calling your state’s Medicaid office or visiting their website.

In general, Medicaid will cover medical equipment that’s medically necessary and cost-effective, and that meets the state’s definition of durable medical equipment. That definition varies, but it’s often similar to the one that Medicare uses. Many state Medicaid programs cover 100 percent of the cost of any home medical equipment you need.

Receiving Medicaid coverage for durable medical equipment typically looks like this:

  • You get a medical justification letter from your medical provider that outlines why you need the item.
  • You choose a Medicaid-approved supplier and give them the letter.
  • The supplier fills out a prior approval application and sends it to the state Medicaid office.
  • The state Medicaid office either approves or denies the claim.
  • If it’s approved, the supplier sends you the DME and sends the bill to Medicaid.
  • If it’s denied, you will receive a letter outlining why, with the option to appeal.
  • Again, the process will vary depending on where you live. We just wanted to give you an idea of what to expect.

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    Medicare Appeals Council Review

    Dissatisfied with the ALJ decisions, CMS asked the U.S. Department of Health and Human Services Medicare Appeals Council to undertake an own motion review. In a decision issued June 11, 2003, the Council reversed the two ALJ decisions..

    The Council found that the claimed equipment was not covered by Medicare. It noted that a CMN is designed to record certain information to help determine whether DME is medically reasonable and necessary. The Council rejected the suppliers arguments that the Social Security Act establishes the CMN as the sole mechanism for establishing coverage of DME and that the Medicare program cannot impose additional documentation requirements for evaluating whether any claimed DME is covered.. According to the Council, no legal support exists for the suppliers proposition that the primary purpose of the CMN is to eliminate the need for any supporting medical documentation to establish medical necessity..

    The Medicare Appeals Council concluded that the supplier had claimed Medicare payment with only a CMN as support, so the equipment was not covered by Medicare. The Council also determined that the supplier had sufficient notice that the items would not be covered without additional medical documentation and, therefore, was liable for the overpayment assessments..

    Where Can I Find A List Of Medicare Approved Suppliers & Vendors

    Medicare/Medicaid & Durable Medical Equipment

    Medicare has setup a database that lists contact information for approved suppliers & vendors for a variety of medical supplies, mobility devices, and other durable medical equipment.

    On January 1, 2011, Medicare began transitioning to the new competitive bidding program so different areas of the U.S. may require that you purchase certain medical supplies and equipment from a particular vendor. As long as you live in the particular area that the supplier covers, theyll be able to file a Medicare claim for you.

    This only applies to certain products. There may be circumstances that an individual would have to go to several different suppliers if they needed several different medical devices.

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    Does Medicare Advantage Cover Medical Alert Systems

    Medicare Part C, also known as Medicare Advantage, is private insurance that provides the same essential benefits as Original Medicare, along with some extras.2 Because private insurance companies offer Medicare Advantage plans, what is included varies by plan and provider. Contact your Medicare Advantage company to find out if they cover medical alert systems.

    Did You Know: Medicare’s annual enrollment period runs from Oct. 15 to Dec. 7 every year. Read our guide to Medicare enrollment to learn everything you need to know about enrollment and coverage.

    What Are Medicares Allowable Limits For Home Medical Equipment

    Medicare has determined the maximum dollar amount their Participating Suppliers are allowed to charge for any particular item of home medical equipment. This is referred to as the allowable limit. Medicare updates this regularly and communicates this information to all their suppliers.

    Ensuring suppliers only charge the allowable limit is a self-regulating process in that Medicare will only reimburse suppliers the allowed amount. If suppliers attempt to bill for more than the allowable limit, they run the risk of not being reimbursed at all.

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    Other Ways To Pay For Durable Medical Equipment

    Sometimes Medicare or Medicaid won’t pay for the item you need, or maybe you just don’t want to wait to find out if what you need will be approved. In either case, here are a few other ways that you can pay for durable medical equipment:

    • Private insurance: Private insurers typically cover durable medical equipment. Speak directly with your private insurer to find out details about coverage.
    • Veterans health care: Veterans and their spouses can turn to the Department of Veterans Affairs for help with a Medicare copayment for DME or with the entire cost of DME. The VA has several programs available, such as CHAMPVA benefits and Tricare.
    • Private pay: Paying out of pocket is always an option, even if you have insurance. You might even find that it’s the quickest way to get the equipment you need. Just make sure you understand the cost difference if you choose to pay for something privately that Medicaid, Medicare, or another insurance policy would cover. Buying DME secondhand often halves the cost, so check eBay or Facebook Marketplace, classified ads, and thrift stores like Goodwill.
    • Nonprofit or state assistance: Some nonprofits, national foundations, and states help seniors pay for durable medical equipment through grants, low-interest loans, assistive technology programs, and financial aid programs. Visit your state’s website or call your local Area Agency on Aging office for assistance in locating available programs.

    When Does Cigna Allow Coverage For Consumable Medical Supplies

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    Consumable medical supplies are covered under Cigna’s coverage policies in conjunction with:

    • Inpatient hospital services
    • Breast reconstruction and breast prostheses

    Additional Managed Care Guidelines:

    • Consumable medical supplies can be allowed under the lead referral/precertification for the associated services.
    • Ostomy supplies are covered.
    • If consumable medical supplies are not provided in conjunction with authorized or referred services, and are not covered under the plan for benefits, they will not be reimbursed by Cigna.

    Note: State or federal legislation and/or plan-specific language supersede Cigna’s administrative coverage policies.

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    Does Medicare Cover Walking Canes

    Your doctor may prescribe a walking cane or a walker to give you the support you need if you have mobility or balance issues. In most cases, if youre enrolled in Medicare Part B, walking canes and walkers your doctor orders for you are covered as part of your Part B benefits.

    Walking canes and walkers are considered durable medical equipment by Medicare and are generally eligible for coverage under your Part B benefits if you meet the requirements listed below.

    • Your health-care provider must accept Medicare assignment.
    • Your doctor must prescribe this equipment for you.
    • You must be enrolled in Medicare Part B or a Medicare Advantage plan.
    • Your supplier for the walking cane must accept Medicare assignment.

    If your doctor orders a walker for you instead of a walking cane, your supplier choice might be affected by Medicares Competitive Bidding Program. You may have to use a medical equipment supplier contracted with the Medicare program.

    Usually, Medicare Part B covers 80% of allowable charges for walking canes and walkers you pay 20% plus any remaining Part B deductible.

    A Medicare Supplement Insurance plan may be able to cover your 20% coinsurance for your walking cane, and other out-of-pocket costs not covered by Medicare Part A and Part B. Learn about Medicare Supplement Insurance plans.

    For more information, see this article on Medicare coverage of durable medical equipment.

    How To Find A Medicare Approved Mattress

    You must be given a prescription for durable medical equipment, so talk to your doctor and see if you qualify.

    There are a lot of benefits to buying a pressure reducing bed. They can improve your sleep, reduce pain and provide extra comfort compared to a normal mattress. Before buying a mattress, read up on your Medicare coverage and see how much of the cost will be covered. You could end up saving a lot of money depending on your health plan.

    There are lots of online retailers that specialize in selling durable medical equipment. With so many options available, youll have to research which one will be the best for you and your health.

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    How To Find Medicare

    The easiest way to find local Medicare-approved DME suppliers is to use Medicare’s official Find Medical Equipment and Suppliers search tool. You can use the tool in two different ways.

    • Method 1: Type in your ZIP code and a supplier’s name to check if they participate in Medicare.
    • Method 2: Type in your ZIP code and the name of the equipment that you need to find a local supplier.

    You can also contact Medicare directly with any questions about equipment coverage or finding a supplier:

    • Online: Log in to your secure Medicare account
    • Phone: 1-800-MEDICARE
    • TTY: 1-877-486-2048

    Once you find a supplier, remember to ask about costs and coverage to ensure that you pay as little as possible out of pocket.

    Recent Developments Highlight The Importance Of Medical Necessity Documentation

    Medicare-approved suppliers of durable medical equipment

    The U.S. Supreme Court recently denied review in a case, reaffirming the long-standing Medicare principle that suppliers must be able to demonstrate the medical necessity of durable medical equipment , such as power wheelchairs and scooters, provided to beneficiaries to receive payment. The Supreme Courts action ended decade-long Medicare payment dispute. Coincidentally, on the same day, the Centers for Medicare & Medicaid Services announced that it was enhanc program integrity efforts to fight fraud, waste and abuse in Medicare..

    CMS Acting Administrator Kerry Weems told attendees at an American Health Lawyers Association conference that the agency was going to zero in on Medicare fraud involving the highest paid DME suppliers and the highest billed equipment and supplies, including power wheelchairs..

    The combination of these two events underscores the importance of securing and retaining documentation of medical necessity for those involved in furnishing DME and submiting claims for Medicare payment. This article discusses these issues further.

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    Purchasing Vs Renting Durable Medical Equipment Through Medicare

    Durable Medical Equipment can end up being quite expensive. You may find equipment available for purchase or rental. In most cases, Medicare pays to rent medical equipment. But Medicare will buy some equipment thats inexpensive like a walker or cane.

    Medicare usually will help with any repairs or replacements you may need for your device. Sometimes you need the equipment longer than a few months. Medicare may buy equipment rather than renting for situations like these.

    Administrative Law Judge Review

    The supplier was unsuccessful in appealing the overpayment determinations at the Medicare carrier level, so it requested review by an administrative law judge ALJ). Two separate ALJ decisions were subsequently issued reversing both carrier overpayment assessments. The claimed DME was determined to be covered by Medicare because the supplier reasonably relied on CMNs signed by the physicians who ordered the equipment.

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    What Types Of Medical Supplies May Qualify For Medicare Coverage

    Only equipment or medical supplies prescribed by your health care provider may qualify for coverage under your Original Medicare Part B benefits, subject to certain restrictions and conditions . In general, the following types of medical supplies or DME would be eligible for Medicare coverage:

    • Hospital beds, lifts, and commode chairs
    • Infusion pumps and supplies

    This list is not comprehensive and your health-care provider and equipment supplier can help you with Medicare coverage of specific items not on this list.

    Federal District Court Review

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    The supplier then requested federal court review. On June 30, 2004, a U.S. district court reversed the Medicare Appeals Council and held that a completed CMN is the only documentation needed to establish the medical reasonableness and necessity of claimed DME.. The judge concluded the Medicare program cannot require that DME suppliersobtain Medicare beneficiaries medical records and make a judgment as to whether the equipment is medically necessary and reasonable.. The Court found that Congressestablished that any and all information required from suppliers to make a medical necessity determination must be contained in a CMN..

    Based on its legal conclusion, the Court enjoined Medicares recovery of the two overpayments. The U.S. Department of Justice, on behalf of CMS, then filed an appeal and asked the Court of Appeals for the Fourth Circuit to reverse the district courts decision.

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    Are There Special Requirements For My Doctor To Be Able To Order A Wheelchair

    Both the doctor and the medical equipment supplier must be enrolled in Medicare in order for the claim to be covered, so double check before you purchase medical equipment.

    And youll want to understand the difference between providers that accept assignment with Medicare and those that dont. A durable medical equipment supplier thats enrolled in Medicare might not accept assignment, which means that the patient will end up paying more for the equipment. As long as the supplier is enrolled in Medicare and also accepts assignment, the patient will not have to pay more than the Part B deductible and 20% of the rest of the cost. .

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