For all health care professionals
and patients needing medical equipment,
Health-E-Quip has the answers to questions
regarding YOU and MEDICARE!
Click here
for specific product coverage information.
Q
What do the
terms "assigned" and "non-assigned"
mean regarding Medicare coverage?
An "assigned" Medicare item means
the supplier accepts the Medicare-approved
fee for the piece of equipment. Medicare
pays the supplier 80% of the approved
fee. The beneficiary pays the 20%
coinsurance. A "non-assigned" item
means the supplier sets the charge
for the piece of equipment. The beneficiary
pays the supplier. The supplier submits
the claim to Medicare. If the item
is covered, Medicare reimburses the
beneficiary 80% of the approved fee.
Q
What does the
term "capped rental" mean regarding
Medicare coverage?
A "capped rental" item means that
the supplier must allow the beneficiary
the option to purchase a rented piece
of equipment during the tenth month
of usage. The beneficiary may choose
to continue renting the item. However,
rental payments must cease after 15
months, and the supplier can charge
a maintenance fee every six months
equivalent to one month's rental.
Q
What is my
Medicare coverage if I get tired of
using a cane and would like a wheelchair
instead?
Medicare does not pay for "conflicting"
equipment. If you can walk with a
cane, Medicare takes the position
that you do not need a wheelchair.
Q
Does Medicare
ever cover two walking aids simultaneously?
You would be able to receive coverage
for both a walker and a wheelchair
to get in-and-out of the wheelchair
when it is a rehabilitation case only.
Q
Does Medicare
cover walkers with wheels and brakes?
Medicare covers the walker with wheels.
Brakes are filed as Non-Assigned claims.
Q
I need oxygen
support occasionally, not continuously.
What is my Medicare coverage?
Medicare does not cover *PRN use of
oxygen. (*PRN = As needed by patient)
Q
What diagnosis
is required for Medicare reimbursement
of CPAP?
The diagnosis must be stated as "obstructive
sleep apnea." Medicare does not cover
a diagnosis stated as "central sleep
apnea."
Q
What is Medicare
coverage of commodes?
Medicare covers commodes only if the
patient is bed or room confined.
Q
What is the
medical information required for Medicare
reimbursement of oxygen?
Medicare reimburses a fixed fee, regardless
of the amount of oxygen used and regardless
of the type of oxygen equipment provided
(such as concentrator, cylinder or
liquid oxygen system).
Medicare reimbursement for oxygen
patients must have a blood gas analysis
report, certifying a PO2 level of
55 mm Hg and/or SaO2 of 88% or below
when at rest and breathing room air.
Re-testing may be required periodically
to establish continued medical necessity.
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