Aging Well

Aging Well

Medicare Coverage for Medical Equipment

Posted May 26, 2020 4:00 p.m. EDT

Ken works for Stall Medical Equipment

While assistive equipment might help a senior stay independent longer, a fair number of people may not pursue it due to cost. It is important to know that, provided an individual qualifies, Medicare will cover 80% of the Medicare allowable expenses. If the patient has a secondary policy, that usually covers the remaining 20%.

What kinds of equipment are we talking about? Equipment might include a wheelchair, a hospital bed, oxygen, a shower chair, a circulating air mattress, or even a bedside commode. Medicare may also cover “consumables,” such as catheters or wound care products, all of which can really add up.

How can I figure out whether my parent (or spouse) is eligible? Find a local medical equipment provider that takes Medicare (not all do) and has the kind of equipment your loved one needs. (I recently had to call four different suppliers to find one that had an available hospital bed and would take Medicare).

What is the process for getting coverage? It's somewhat complicated. For answers, I reached out to Ken Muzillo, Assistive Technology Professional (ATP), of Stalls Medical , who has helped hundreds of clients over his career. We concentrated on the most common need he encounters: getting a wheelchair. He first noted, though, that the client must be both willing and able to use whatever mobility device they are seeking.

Here are the steps:

  1. A physician, Physician Assistant, Nurse Practitioner, or Physical or Occupational Therapist identifies the patient’s need.
  2. The physician or PA has an in-person visit with the patient and documents the need. They also write a Medical Order for a Physical or Occupational Therapist wheelchair seating assessment. The Medical Order must clearly state the qualifying diagnosis and date.
  3. The seating evaluation will detail the client’s physical presentation, limitations, and mobility needs. The Assistive Technology Professional (ATP) attends the evaluation with the client.
  4. The ATP then performs a home assessment to determine whether or not the desired equipment will work in the home. They also conduct the equipment trial after it’s been delivered.
  5. A case worker from the Durable Medical Equipment Provider will review the physician chart notes and the seating evaluation. They will send the physician a “seven element prescription form,” which the doctor must sign and date.
  6. The case manager develops a detailed product description, which lists all of the charge items for the insurer, and which the doctor must also sign and date.
  7. Then the case worker sends the whole package off to the insurer.
  8. If the request is denied, the case worker pursues any further information requested in order to resubmit.
  9. Once approved, the case worker also informs the client of any out of pocket expenses, and provides a timeframe for receiving their new chair.

Clients should expect to wait two to four months for complex rehab wheelchairs. Equipment related to hospice care is often delivered within 24 hours of the Medical Order.

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