CERTIFICATE OF MEDICAL NECESSITY
QUESTIONS
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NOTE: Questions in
this section should be answered accurately
to reflect the true condition of the
patient. Your answers to specific
questions are used by Medicare to
establish whether specific items are
reimbursable. For example, a "YES"
answer to either Question 3 or 4 or
5 qualifies the patient for Medicare
reimbursement.
Question 1: Patients
who require positioning of the body
in ways not feasible with an ordinary
bed due to a medical condition which
is expected to last at least one month
qualify for Medicare reimbursement.
Question 3: Patients
who require, for the alleviation of
pain, positioning of the body in ways
not feasible with an ordinary bed
qualify for Medicare reimbursement.
Question 4: Patients
who require 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 aspiration qualify for Medicare
reimbursement.
Question 5: Patients
who require traction which can only
be attached to a hospital bed qualify
for Medicare reimbursement.
Question 6: Patients
who require a bed height different
than a fixed height hospital bed to
permit transfers to chair, wheelchair,
or standing position qualify for Medicare
reimbursement. If the answer is "NO",
Medicare will down-code to a fixed-height
bed.
Question 7: Patients
who require frequent changes in body
position and/or have an immediate
need for a change in body position
qualify for Medicare reimbursement.
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NOTE:
For a fixed or variable height
hospital bed a "YES"
or "NO" answer qualifies for Medicare
reimbursement.
NOTE: For a semi-electric
hospital bed a "YES"
answer qualifies for Medicare reimbursement.
NOTE: Total electric hospital
beds are not covered by Medicare.
If supplied, the allowable will be
down-coded.
NOTE: If documentation
does not support the medical necessity
of the bed ordered but does support
the medical necessity of a lower-level
bed, payment will be based on the
allowable for the least costly alternative
(down-coded). |
Information courtesy of Health-E-Quip
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