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Medicare and Medical Expense Reimbursement for DME

Marc Kaplan


Are you taking every advantage to seek reimbursement under Medicare Part B? Do you have a medical condition that requires durable medical equipment in your home? To make sure you get all the money back that you deserve, check out this simple guide!

What Is Durable Medical Equipment?

Durable medical equipment helps to provide treatment of illnesses and diseases. The defining characteristics of durable medical equipment are portability, reliability and durability. The device should also be robust enough to last a long time and be able to provide in-home treatment of medical issues.

You may not be aware of the massive variety of medical devices and tools that qualify as durable medical equipment. They include oxygen equipment, canes, commode chairs, walkers, wheelchairs and more. If you happen to be a member of Medicare Part B, you can be reimbursed or have your equipment qualify for significantly lower costs.

If you or a loved one have a chronic medical condition that requires durable medical equipment, you know that getting reimbursement is very important. Without it, you will end up paying more than you should for repair and maintenance, supplies, refills, deliveries and much more.

In order to make sure that you don't pay more than you need to, you should be aware of what is covered and what is not. Knowing the requirements to get your durable medical equipment covered under Medicare Part B could make or break your wallet.

You should know that durable medical equipment does require a prescription from a doctor for you to rent or purchase. Also, there are several types of medical equipment that are not considered durable. These include items with a single or limited number of uses, such as incontinence supplies and face masks.

Medicare Part B and How It Can Make Your Life Easier

In order to receive any coverage from Medicare, you must make sure that your doctor or medical provider is part of the Medicare network. If they are not involved with Medicare, no claims you make through them will even be considered.

Any durable medical equipment suppliers must also be members of the Medicare network for you to receive coverage. If the supplier does not receive an "assignment" from Medicare, you will be left to cover the full costs of any equipment. This can even include hospital beds, which normally cost a great deal of money.

Making sure your suppliers accept the "assignment" is very important, as the costs can vary widely. If the "assignment" is not accepted, there is no cap on how high the cost of your durable medical equipment could be.

However, there are several limits on the type of durable medical equipment that Medicare will cover. For example, a powered wheelchair will only be covered if you need it to move around your own home. If you do not need the equipment to perform basic functions, you may have to do without it.

Once the supplier accepts the "assignment," you will only have to put down twenty percent of the equipment costs. This is one of the main benefits of the Medicare Part B deductible. Depending on the type of durable medical equipment needed, you may be required to rent or buy what you need.

You will also have to consult with your doctor or medical provider to examine what your options are. Depending on the type of insurance you have, whether your doctor accepts "assignments" and even how much they charge can make a difference. The type of medical facility and the location where you get your durable medical equipment has an impact on prices.

How to Submit a Reimbursement Claim

While you should be fine in the majority of cases, your durable medical equipment supplier may not submit your claim. In this event, you will have to submit your claim directly to Medicare.

You should know that that claim you are filing for must be within the last twelve months from the purchase of the equipment. Any supporting documents like an itemized bill must also be included with the Medicare form.

Any home improvements or modifications such as a wheelchair ramp or grab bars are not currently covered by Medicare. However, these expenses may be classified as supplemental benefits in the near future, so you should be aware of any legal changes.

You can download a reimbursement form directly from Medicare's website. This form is known as a Patient Request for Medical Payment form. The form must be filled out completely and with due care, or you may run the risk of having your claim refused. You also have to include a detailed explanation of why you are submitting the form.

If you are seeking reimbursement for medical equipment, you will need a lot of information. This includes your doctor's treatment plan, including how long you will need the equipment. You will also need information on any predicted medical outcomes, your doctor's level of supervision and a detailed account of your functional and clinical status.

You will also have to make sure you send your claim to the correct address. If you send your forms and information to the wrong PO box and address, you could end up delaying your claim significantly.

Rental and Purchasing Guidelines for Durable Medical Equipment

Equipment valued at less than $200 is classified as routine or inexpensive, making them ineligible for rental. Items that are considered highly technical or need specialized maintenance may also be considered ineligible.

If you choose to rent your equipment, you should be aware that your benefits cannot exceed the purchase price of equipment. Renting the equipment past the contracted fee schedule is not permitted either.

Get The Most out of Medicare

Dealing with a long-term medical issue can be mentally draining and demanding. By knowing what you can be reimbursed for under Medicare Part B, you can save you and your loved ones time and money on durable medical equipment. If you want to learn more about what you can be reimbursed for, check out Save Rite Medical today!