Obtaining medical equipment through Medicare is not as simple as it used to be. In the past, you could take a doctor’s prescription and your Medicare card to your local medical supply company and pick up the items you need. A few years ago, however, CMS began to make it more difficult for patients and their physicians to navigate the system and to get approval for needed equipment
The following equipment is included in what is considered “durable medical equipment” or “DME” that Medicare covers:
Braces and splints
Gel pads and air mattresses for hospital beds
Certain wound care items
The New Face-to-Face Requirement
For an item to be covered by Medicare, a prescription from the physician is always required. In the past, however, for basic equipment a patient could just pick up a prescription or have the doctor’s office fax it to the supply store without having an appointment with the doctor.
Now, however, Medicare requires an actual face-to-face visit with the doctor. The evidence of the face-to-face meeting must be in the form of chart notes, which are the written notes a doctor takes during each patient visit. This means that a prescription alone is no longer enough. The patient can bring the prescription to the medical supply store, but the store will have to contact the doctor to obtain the chart notes before the item can be dispensed.
This process can take some time. In addition, if by chance the doctor forgets to note the need for the equipment in the chart notes, the chart notes will have to be properly amended to meet the requirement.
Stricter Interpretation of Rules
Not only must the chart notes be provided, but the language in the chart notes must meet certain specific standards. Medicare has always had rules that state the requirements for each product, but now they are enforcing these rules more strictly. Thus, for most products the chart notes must have precise verbiage that corresponds to the specific product ordered.
For example, for a wheelchair the chart notes must state that the patient (i) has a gait dysfunction, (ii) cannot safely use a cane or walker and (iii) is able to self-propel the wheelchair or has a caregiver who can push the chair.
For a portable commode, the chart notes must state, in general, that the patient is confined to a single room and is incapable of ambulating to the bathroom. This means, for example, that commodes for convenience or to raise the height of a toilet seat are no longer allowed.
For a hospital bed, the requirements are more complicated. The chart notes must state, in general, that (i) the patient’s medical condition requires positioning in ways not feasible with an ordinary bed and (ii) the patient requires frequent changes in body position. Based on this requirement, a patient with a respiratory ailment would most likely qualify for the bed, but a patient with a lesser or different ailment might not qualify.
The foregoing explanations are general summaries and should not be relied upon without the benefit of specific advice from a doctor or the medical supplier. The point, however, is that these new rules and interpretations make the process to obtain equipment more complicated.
How can you deal with these new requirements? First, it is a good idea to consult with your medical equipment supplier as soon as you are aware of the need for equipment. They can tell you what the requirements are and help with the process. Second, leave extra time whenever possible before the equipment is needed.
Try not to wait until the last minute to obtain a walker, wheelchair or hospital bed through Medicare. And third, select a medical equipment supplier who is experienced in the process and has good relationships with local medical professionals. These steps will make it easier for all involved and will speed the approval process.
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Kin-Care has been working with Medicare and local medical professionals for over 25 years.
We are one of South Florida’s leading sources for medical equipment and mobility products. We promise knowledgeable advice, uncompromising quality, and dedication to assisting those with special needs. We can help make sure you get the product that’s right for you.
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Boca Raton, Florida 33434
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