Overview
The Centers for Medicare & Medicaid Services
(CMS) administers Medicare, the nation's largest health insurance
program, which covers 39 million Americans.
Medicare is a Health Insurance Program for people
65 years of age and older, some disabled people under 65 years of age,
and people with End-Stage Renal Disease (permanent kidney failure
treated with dialysis or a transplant).
For more information click here:
http://medicare.com
GENERAL MEDICARE INFORMATION
for Power Wheelchairs, Scooters, and Seat Lift Chairs
Medicare is a federally funded health
insurance program, designed to provide health insurance to people age 65
and over and certain people with disabilities. The Health Care Financing
Administration (HCFA) runs the Medicare program, and the Social Security
Administration helps by enrolling qualified participants into the
program.
Medicare has two parts. Part B is the
medical insurance part of Medicare that pays for Durable Medical
Equipment (DME). In order for Part B carriers to be reimbursed for DME,
two conditions must be met. First, the DME must be necessary and
reasonable either in the treatment of an injury or illness, or in
improving the function of an impaired body part. Second the DME must be
for use in the individual's home. The necessary part of the first
requirement is met by obtaining a doctor's prescription that includes
the diagnosis and prognosis for the individual, the reasons behind
prescribing the DME, and the length of time that the DME will be needed.
The requirement for reasonableness is much more complex. The
guidelines the Part B carrier can use in determining reasonableness
include weighing the expense against the anticipated therapeutic
benefits, investigating less costly alternatives, and determining if the
DME will serve the same purpose as equipment readily available to the
individual. If the DME fails the reasonableness test, reimbursement in
full is usually denied.
Eligibility Requirements
Medicare is health insurance
coverage for those persons who are either 65 years of age or older, who
are blind, totally and permanently disabled and have been receiving
Social Security disability payments for 24 months, or who have end-stage
renal disease. Many Medicare recipients are also eligible for
Medicaid benefits. In those cases Medicaid will pay the Part B
insurance premiums plus the co-insurance and deductible amounts and
other charges sponsored by Medicaid but not covered by Medicare.
Application Process
You can apply for Medicare at
the local offices of the Social Security Administration.
Social Security
Power Wheelchair Reimbursement
Most power wheelchairs are
recognized and qualify for potential reimbursement under Medicare and
other Health Care Insurance Companies.
If you need a power chair for mobility
and you meet your insurance's coverage guidelines, they may pay for all
or part of the cost of the power chair. Coverage criteria and
payment amounts will vary depending on the type of insurance you have.
Most health care insurance companies, including Medicare, have minimum
requirements that need to be met before they will purchase a power chair
for you.
Motorized/Power Wheelchair
Medicare Coverage Criteria
A power wheelchair is covered when all of the following criteria are
met:
1.
The patient' s condition is such that without the use of a wheelchair
the patient would otherwise be bed or chair confined; and,
2. The patient' s condition is such that a wheelchair is
medically necessary and the patient
is unable to operate a wheelchair manually; and,
3. The patient is capable of safely operating the controls for
the power wheelchair.
A patient who requires a power
wheelchair usually is totally nonambulatory and has severe weakness of
the upper extremities due to a neurologic or muscular disease/condition.
If the documentation does not support the medical necessity of a power
wheelchair the power wheelchair will be denied as not medically
necessary. Options that are beneficial primarily in allowing the patient
to perform leisure or recreational activities are noncovered. A
power wheelchair is covered if the patient' s condition is such that the
requirement for a power wheelchair is long term (at least six months).
Payment is made for only one wheelchair at a time. Backup chairs are
denied as not medically necessary. Reimbursement for the power
wheelchair includes all labor charges involved in the assembly of the
wheelchair and all covered additions or modifications. Reimbursement
also includes support services, such as emergency services, delivery,
set-up, education, and on-going assistance with use of the wheelchair.
If you feel you meet these requirements,
you may be eligible to receive the most stylish, best performing and
most reliable power chair available on the market today at little or no
money out of pocket.
Beneficiary Information
Power Wheelchair
Dear Medicare Beneficiary,
You may be eligible to receive a portion of your money back from
Medicare when you purchase a power wheelchair. To qualify you must
have Medicare Part B coverage and meet certain medical coverage criteria
as determined by your physician.
Here are some common questions regarding
Medicare Reimbursement.
Will Medicare pay for a Power Wheelchair?
If you qualify, Medicare will pay for a portion of your power
wheelchair.
If I qualify, how much will Medicare pay towards the purchase of a power
wheelchair?
Medicare will pay 80% of a set allowable for a power wheelchair.
The amount depends the type of power wheelchair you choose and on your
state of residence. On average the amount reimbursed by Medicare
is around $4,000.00.
How do I know if I qualify?
Medicare has certain medical
criteria that need to be met before Medicare will pay for a power
wheelchair. Medicare requires a Certificate of Medical Necessity,
also known as a CMN, to be completed by your physician
How do I submit a claim to Medicare? What other information
needs to be sent?
Once a completed CMN signed by the physician is obtained we will
submit a claim along with the CMN to Medicare on your behalf.
Medicare will process your claim and inform you of their payment
decision in about 30-45 days.
Can I find out if I medically qualify before I purchase the Power
Wheelchair?
No, Medicare does not have a Prior Authorization process available
at this time
Motorized Scooter Reimbursement
Most Scooters or Power Operated
Vehicles (POVs) are recognized and qualify for potential reimbursement
under Medicare and other Health Care Insurance Companies as a power
operated vehicle or (P.O.V.).
If you need a scooter for mobility and you meet your insurance's
coverage guidelines, they may pay for all or part of the cost of the
scooter. Coverage criteria and payment amounts will vary depending
on the type of insurance you have. Most health care insurance
companies, including Medicare, have minimum requirements that need to be
met before they will purchase a scooter for you.
Power Operated Vehicles (POVs)/Scooters
Medicare Coverage Criteria
A power operated vehicle (POV) is covered when all of the following
criteria are met:
1.
The patient's condition is such that a wheelchair is required for the
patient to get around in the home,
2. The patient is unable to operate a manual wheelchair,
3. The patient is capable of safely operating the
controls for the POV, and
4. The patient can transfer safely in and out of the POV
and has adequate trunk stability to be able to safely ride in the POV.
Most POVs are ordered for patients who
are capable of ambulation within the home but require a power vehicle
for movement outside the home. POVs will be denied as not
medically necessary in these circumstances.
If you feel you meet these requirements, you may be eligible to receive
the most stylish, best performing and most reliable scooter available on
the market today at little or no money out of pocket.
Beneficiary Information
Motorized Scooter
Dear Medicare Beneficiary,
You may be eligible to receive a portion of your money back from
Medicare when you purchase a scooter. To qualify you must have
Medicare Part B coverage and meet certain medical coverage criteria as
determined by your physician.
Here are some common questions regarding
Medicare Reimbursement.
Will Medicare pay for a Scooter?
If you qualify, Medicare will
pay for a portion of your scooter.
If I qualify, how much will Medicare pay towards the purchase of a
scooter?
Medicare will pay 80% of a set allowable for a scooter. The amount
depends on your state of residence. On average the amount reimbursed by
Medicare is around $1440.00
How do I know if I qualify?
Medicare has certain medical
criteria that need to be met before Medicare will pay for a scooter.
Medicare requires a Certificate of Medical Necessity, also known as a
CMN, to be completed by a physician who is a specialist in: Physical
Medicine, Rheumatology, Orthopedics, or Neurology.
How do I submit a claim to Medicare?
What other information needs to be sent?
Once a completed CMN signed by
the physician is obtained and after you purchase the scooter, we will
submit a claim along with the CMN to Medicare on your behalf.
Medicare will process your claim and inform you of their payment
decision in about 30-45 days.
Can I find out if I medically qualify
before I purchase the scooter?
Yes, Medicare has a Prior
Authorization process available that will determine if your condition
satisfies the Medicare coverage criteria. To apply for Prior
Authorization, have your physician complete and sign CMN 07.02B.
We will submit the request to Medicare for you. Medicare will let
you know in about 3-4 weeks if you medically qualify for a scooter.
Seat Lift Chair Reimbursement
Most Seat Lift Chairs are
recognized and qualify for potential reimbursement under Medicare and
other Health Care Insurance Companies.
If you need a lift chair and you meet
your insurance's coverage guidelines, they may pay for all or part of
the cost of the lift chair. Coverage criteria and payment amounts
will vary depending on the type of insurance you have. Most health
care insurance companies, including Medicare, have minimum requirements
that need to be met before they will purchase a lift chair for you.
Seat Lift Chairs
Medicare Coverage Criteria
A seat lift mechanism is covered if all of the following criteria are
met:
1.
The patient must have severe arthritis of the hip or knee or have a
severe neuromuscular disease.
2. The seat lift mechanism must be a part of the
physician's course of treatment and be prescribed to effect
improvement, or arrest or retard deterioration in the patient's
condition.
3. The patient must be completely incapable of standing
up from a regular armchair or any chair in their home. (The fact that
a patient has difficulty or is even incapable of getting up from a
chair, particularly a low chair, is not sufficient justification for a
seat lift mechanism.
Almost all patients who are capable of
ambulating can get out of an ordinary chair if the seat height is
appropriate and the chair has arms.)
4. Once standing, the patient must have the ability to
ambulate.
Coverage of seat lift mechanisms is
limited to those types which operate smoothly, can be controlled by the
patient, and effectively assist a patient in standing up and sitting
down without other assistance. Excluded from coverage is the type of
lift which operates by spring release mechanism with a sudden,
catapult-like motion and jolts the patient from a seated to a standing
position. Coverage is limited to the seat lift mechanism, even if
it is incorporated into a chair.
If you feel you meet these requirements,
you may be eligible to receive the most stylish, best performing and
most reliable lift chair available on the market today.
Beneficiary Information
Seat Lift Chair
Dear Medicare Beneficiary,
You may be eligible to receive a portion of your money back from
Medicare when you purchase a Seat Lift Chair. To qualify you must
have Medicare Part B coverage and meet certain medical coverage criteria
as determined by your physician.
Here are some common questions regarding
Medicare Reimbursement.
Will Medicare pay for a Seat
Lift-Chair?
If you qualify, Medicare will
pay for a portion of your Seat Lift-Chair. The portion that
Medicare will pay for is the seat lift mechanism that is incorporated
into a Seat Lift-Chair.
What is a seat lift mechanism?
The seat lift mechanism is the
portion of the lift chair that gently lifts you to a standing position.
It includes the metal frame on which the chair rests, the lift motor,
the scissors mechanisms and the hand control unit.
If I qualify, how much will Medicare
pay towards the purchase of a Seat Lift-Chair?
Medicare will pay 80% of a set
allowable for a seat lift mechanism. The amount depends on your
state of residence. On average the amount reimbursed by Medicare is
around $250.00.
How do I know if I qualify?
Medicare has certain medical
criteria that need to be met before Medicare will pay for a seat lift
mechanism. Medicare requires a Certificate of Medical Necessity,
also known as a CMN, to be completed by your physician based on your
medical condition. Generally, Medicare will only pay for the seat
lift mechanism if the patient has a neuromuscular disease or severe
arthritis of the hip or knee that completely prevents the patient from
standing up from a regular armchair or any chair in their home.
Medicare also requires that once standing the patient must have the
ability to ambulate. Additionally, the seat lift mechanism must be
part of the physician's course of treatment and be prescribed to effect
improvement, or arrest or retard deterioration in the patient's
condition.
How do I submit a claim to Medicare?
What other information needs to be sent?
Once you have a completed CMN
signed by your physician and after you purchase the Seat Lift-Chair, we
will submit a claim along with the CMN to Medicare on your behalf.
Medicare will process your claim and inform you of their payment
decision in about 30-45 days.
Medicare Carrier by State
If you reside in:
CT, DE, ME, MA, NH, NJ, NY, PA, RI, VT
Your Medicare Carrier is:
United Healthcare
Region A DMERC
PO Box 6800
Wilkes-Barre, PA 18773
Phone: (800) 842-2052
If you reside in:
DC, IL, IN, MD, MI, MN, OH, VA, WV, WI
Your Medicare Carrier is:
AdminiStar Federal
Region B DMERC
PO Box 7031
Indianapolis, IN 46207
Phone: (800) 270-2313
If you reside in:
AL, AR, CO, FL, GA, KY, LA, MS, NM, NC, OK, SC, TN, TX
Your Medicare Carrier is:
Palmetto GBA
Region C DMERC
PO Box 100141
Columbia, SC 29202-3235
Phone: (800) 213-5452
If you reside in:
AZ, AK, CA, HI, ID, IA, KS, MO, MT, NE, NV, ND, OR, SD, UT, WA, WY
Your Medicare Carrier is:
CIGNA
DMERC Region D
PO Box 690
Nashville, TN 37202
Phone: (800) 899-7095
For more information click here:
http://medicare.com |
