Home Medical Equipment (HME)

Finally, Some Good News for Medicare Recipients

Durable equipment, such as wheelchairs, walkers, hospital beds and other medical equipment has long been the subject of frustration because of their costs.  If an individual has Medicare, often Medicare pays for some or all of these items, with little cost to the recipient.

 

However, the costs of much of this equipment are extremely high, and not affordable to most Medicare recipients.  Even though Medicare helps with the expenses, there are still issues that are being addressed. 

 

Medicare has determined that the costs are too high for them, as well.  They have proposed a solution that would help consumers and help the Medicare program itself.  To save money for recipients and the Medicare system, Medicare wants to institute a competitive bidding process for some durable medical equipment.  This would mean that companies that supply these items would have to bid toward the lowest price in order to be given contracts through Medicare.  In addition, these lower price savings would be passed on to Medicare Beneficiaries. 

 

On the surface this seems like a good idea, and in many cases, it would work.  The problem is that many of the companies that provide this equipment are small businesses that have a small profit margin.  Some of these businesses have no room to decrease their prices and as a result, might be shut out of the process of providing durable equipment through Medicare.  This could severely cripple the businesses or even put them out of business.

 

Another drawback is that there would probably be fewer choices for Medicare recipients along with fewer knowledgeable providers.  Patients might have to switch from their current providers to a new one that they don’t know.  Some beneficiaries have been affected already, as the bidding process has started. It is taking longer to get their equipment.  A high percentage of providers have already had to cut back or go out of business.

 

In the long run, things will even out.  In the short term, however, if you are a Medicare recipient, try to deal with durable equipment in advance.  Put your order in early, and try to be patient as everything is sorted out.  We can all be hopeful that the discounts will truly be passed on, saving beneficiaries money on essential equipment they need.

 

Medicaid to Involve more Home Health Care

During the past decade or more, there has been a push by citizens, advocates and, yes, even congress, to allow individuals to have home health care rather than staying in a facility.  As many of us know, a person that can live at home and interact in the community, while being taken care of medically, will most likely live a longer and fuller life.

One state, Connecticut, has moved into the cadre of states who are working to allow individuals to stay at home, get home health care, and live full lives.  Senators there have passed a bill that will move about 5,000 individuals who are elderly or disabled out of care facilities and institutions back to their homes and their communities.

This is vitally important.  Statistics have shown that individuals that have community support and independent living, live longer and are healthier than those who are confined to hospitals, institutions and long-term care facilities.  This does not mean that everyone is capable of living on their own and interacting in the community without assistance.  Some individuals might be better in a variety of care settings.  However, it has long been known that there are many individuals in facilities, hospitals and institutions that should really be able to live in the community.

This is a win-win situation.  Medicaid will save money – it is much less costly to live in a group home or apartment and have a variety of supports defraying the costs, than it is to stay in a hospital, facility or institution where rates range (depending on the area the person lives in) from nearly $200 per day to over $1,000 per day.

I have personally worked in several states with individuals who were involved in independent living programs.  Some lived in group homes and others lived in their own apartment.  Still others were able to live at home with their families.  Many of them had gainful employment, meaning that in many cases, they either needed less benefits and actually paid taxes, helping the economy; or they had small jobs that prepared them to move forward in the community and eventually be self-sufficient.

No matter what the situation, helping individuals that are able to integrate into the community and work toward independence is a huge step forward for the individual, the community they live in, and society in general. 

At this time, it looks as though the trend has caught on and is continuing.  In the long run, it can save Medicaid and communities millions of dollars.  In the short term and the long run, it will heal individuals, families, and the community and make all of these entities stronger and richer for the progressive change.

Medicare Diabetic Supplies: The Medical Supplies Covered By Medicare for Diabetics

As a person who is diabetic, you know that you need special devices in order for you to properly monitor your blood glucose levels. This is essential in managing the diabetes disease effectively and helps you live a more normal and fulfilling life as well as preventing complications that is associated with diabetes.

If you have Medicare, you will want to know about the coverage it provides for diabetics. Basically, you will see that the Medicare Part B will be able to cover different kinds of equipments that is specially designed for use for diabetics.
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Medicaid Electric Wheelchair Coverage: Information about Medical Equipments and Medicaid

If you are having problems with mobility then you will most liekly need an electric wheelchair to do your daily activities. However, you have to consider the fact that not all people can afford such equipments.

If you have Medicaid, then you will see that this healthcare program provided by the state and federal government of the United States will be able to help you out in terms of financing the purchase of the equipment.

However, you need to understand that before you purchase the wheelchair, you have to remember that Medicaid will only cover the expenses if you buy the wheelchair from an approved supplier. According to the Durable Medicaid Equipments or DME, not all suppliers of electric wheelchair will be able to bill Medicaid. However, by keeping the receipt, you will be able to reimburse part of the expense when you brought the electric wheelchair.

In order to become covered, you have to be legally disabled and your doctor should prescribe you the equipment.

As you can see, it is quite easy to be covered by Medicaid when you need an electric wheelchair. However, you have to remember that not all types of Medicaid will be able to cover the full cost of buying the electric wheelchair. You will also need to pay for a part of the expense.

So, if you are under Medicaid and that you are in need of electric wheelchair to make life easier for you to live, you will see that Medicaid will be able to share the cost of buying the equipment or if you are under the managed care plan, you will see that Medicaid will be able to cover all the cost.

Electric Wheelchairs and Medicare: What is Covered?

If you’re having mobility problems you might qualify for an electric wheelchair under Medicare coverage. An electric wheelchair solution can greatly improve the quality of life for mobility impaired patients and is well worth considering as an available option.  The new Electric wheelchair provisions from May 2005, allow for partial or complete coverage of an electric wheelchair, based on the need of the patients.

Patients requesting an electric wheelchair must show that their mobility impairments are interfering with their ability to take care of themselves within the home. Medicare will want to know if your mobility problems interferes with essential daily activities such as, toileting, feeding, dressing, grooming and bathing in the usual locations in the home.

 

Medicare will also want proof that an electric wheelchair is the best solution, and will want documentation on, why a cane or walker won’t solve the mobility issues? Why a conventional manual wheel chair cannot be used? Why an electric scooter cannot be used? Whether the patient has the mental and physical faculties to operate an electric wheel chair; and whether the patient has demonstrated a desire for, and a willingness to learn how to use, the electric wheelchair?

Medicare will also want to see that the patient can safely transfer in and out of the electric wheelchair, and that the person has the necessary core trunk strength and stability to safely operate an electric wheelchair. Medicare will also insist that the patient not have successfully filed a claim for reimbursement for the purchase of an electric wheelchair in the previous five years.

 

These questions will need to be answered by your physician, so you will need to get a face to face mobility evaluation from a registered physician before proceeding with your application for an electric wheelchair.  Normally, Medicare insists that the consulting physician be a licensed neurologist, orthopedic surgeon, rheumatologist, or rehabilitation medicine specialist. Medicare will cover up to 80% of the total cost of the wheelchair, and additional insurance coverages often pay for the balance of the cost.

Claims issued to Medicare for an electric wheel chair will be settled within 30 days of receipt of the claim. Medicare clients are advised to apply for pre approval prior to purchasing the electric wheel chair, to ensure that payment is made.

Although the number of claims approved by Medicare has went up substantially in the last ten years, studies have shown that these approvals have actually resulted in a net savings for Medicare. Patients who receive adequate mobility assistance devices are far less likely to suffer a broken hip or other related ailment.

Hoveround: A Look at Hoveround Electric Wheelchairs and Medicare

Hoveround electric wheelchairs are popular mobility solution for people having trouble getting around as much as they’d like to; and with your doctor’s help these mobility solutions are almost completely, or is some cases 100%, covered. These electric wheelchairs can greatly improve the quality of life of someone who, because of pain or disability, cannot get out of the house as much as they’d like.


The Hoveround Company lists four reasons why their electric wheelchairs will improve the quality of life for any mobility compromised person.

They assert that a Hoveround wheel chair can allow a person increased independence. Once they’re able to get around on their own, they are much less reliant on the assistance of others to get out of the house and do what they like.

They promise that the increased mobility offered by a Hoveround wheelchair will give you the power to reconnect with the important people in your life; and that no longer does anyone need miss out on family events due to impaired mobility.

They say that the Hoveround wheelchairs are very easy to use. Anyone can learn to maneuver the easy to use chair in an hour or two, and safety features make the possibility of accidents very low.

They also boast of great ergonomics. The chair has been specially designed for all-day comfort. A sore back won’t keep you from getting out in the world with family and friends.

These mobility solutions are considered necessary medical equipment, and as and such are covered under Medicare; so there’s really no financial barrier to ownership if you and your physician agree that you would benefit from a way to get around easier.

As of may 5 2005, Medicare now covers power wheelchairs for people who have a mobility deficit that impairs their ability to participate in the mobility-related activities of daily living. Patient who think that they might need an electric wheelchair are encouraged to consult with a physician for a face to face evaluation of mobility, and for a determination of what mobility aid is best suited.

Medicare will likely need to know, what the specific mobility deficits are, and how they interfere with daily life. Why a cane or walker won’t suffice? Why a manual wheelchair won’t meet the patients mobility needs, and whether or not the patient has the mental and physical capacity to operate the electric wheelchair?
If you and your doctor feel that an electric wheelchair might benefit your circumstances, you might well be covered for most of the purchase cost under Medicare. Talk with your doctor about how to get started on the application process.

The Scooter Store Wants to End Medicare’s “In the Home” Requirement for Electric Wheelchairs and Scooters

The Scooter Store, the nation’s largest supplier of power wheelchairs (electric wheelchairs) and mobility scooters, today announced it supports changes to the Social Security Act that would eliminate language restricting power wheelchairs and scooters obtained through Medicare to use inside a person’s house or home.

Below is the actual press release from The Scooter Store released today:

The SCOOTERStore announced today its full support for revisions to the Social SecurityAct that would eliminate language restricting power wheelchairs and
scooters obtained through Medicare to use inside a beneficiary’s home.
    Organizations representing people living with disabilities, such as the
Independence Through Enhancement of Medicare and Medicaid Coalition (ITEM), have deplored the restriction, saying it unfairly limits Medicare coverage
and prevents many people who need mobility devices from obtaining it.
    Two members of the United States House of Representatives, James
Langlevin (D-RI.) and Jim Ramstad (R-MN), have sponsored legislation that
would amend the Social Security Act and significantly increase mobility for
Medicare beneficiaries. Under the revision, beneficiaries could obtain
power wheelchairs and scooters that allow them to perform daily activities
outside of their home, such as going to church, the bank and grocery
shopping.
    “It’s clear that removing this restriction can vastly improve the
quality of life for Medicare beneficiaries in need of mobility equipment,”
said Doug Harrison, CEO and founder of The SCOOTER Store. “Physicians want
patients with mobility impairments to become as active and mobile as
possible. This change in Medicare regulations is long over due, and will
put the coverage criteria more in sync with today’s medical practices.”
    The “in the home” language was originally drafted to differentiate
between Durable Medical Equipment (DME) used in hospitals and nursing homes
from equipment that was used outside of those facilities, such as in a
beneficiary’s home. Over the years, however, the government interpreted the
language differently, and used it to restrict Medicare coverage to power
wheelchairs and scooters that beneficiaries needed to perform daily
activities exclusively in their homes.
    Sen. Jeff Bingaman (D-NM) is likely to reintroduce legislation in the
Senate, which would accomplish the same goal as the house legislation. Sen.
Bingaman, with former Sen. Rick Santorum (R-PA), last year sponsored the
Medicare Independent Living Act, a measure that would have removed the
restriction.
    “We look forward to the day when seniors and people living with
disabilities can obtain mobility equipment that will increase their
mobility both inside and outside of their homes,” Mr. Harrison said. “This
legislation is a Declaration of Independence for seniors and people with
mobility impairments. It can give them freedom and independence, and allow
many people to engage actively in their communities.”
    About The SCOOTER Store
    Since 1991, The SCOOTER Store has helped provide freedom and
independence to more than 280,000 people with limited mobility. The SCOOTER
Store offers a full line of durable medical equipment, including power
wheelchairs and scooters, lift, ramps and accessories through 47 states.
The SCOOTER Store has worked with more than 100,000 physicians, providing
expertise and quality service to their patients, and is accredited by the
Accreditation Commission for Health Care. For additional information, visit
The SCOOTER Store website at http://www.thescooterstore.com.

For more information about the Social Security Act, you can visit the official webpage at http://www.ssa.gov/OP_Home/ssact/comp-toc.htm.

The Scooter Store Medicare Fraud – a Brief History

The Scooter Store is the nation’s largest provider of powered mobility, which includes electric wheelchairs and scooters. Founded by Doug Harrison, the company has recently battled Medicare over allegations that it committed fraud or abused the Medicare system.

 

The Scooter Store has filed counterclaims against Medicare and the Federal government. Below are a few links regarding The Scooter Store and its battles with Medicare:

Here are a few more links relating to the Scooter Store, the power mobility industry and the battles against fraud:

 

Types of Power Wheelchairs

Most medical equipment supply companies offer a vast line of electric wheelchairs. The different versions will vary by size, weight capacity and other options. There are oversized chairs for bariatric (or obese) patients. There are smaller chairs for children and petite adults. There are also different seats, colors and footpads for chairs.

The options for electric wheelchairs can vary depending on a person’s needs. Some people need elevating leg rests (ELRs) to keep good circulation in the legs. Others might need an oxygen tank holder to carry portable oxygen tanks. People with ulcers and sores might need specialty seating.

Pride Mobility Products Corp., Invacare Corporation and Hoveround manufacture the three most common electric wheelchair brands in the United States. Although there are many different companies that manufacture this equipment, these three easily have the most popular brand name recognition.

Pride Mobility is a company that specializes in manufacturing power mobility devices and vehicle lifts. It is responsible for the Jet, Jazzy and Quantum lines of electric wheelchairs. The Jet series includes the Jet 3 Ultra, the Jet 2HD, the Jet 7 and the Jet 10 electric wheelchairs.

The more popular line is the Jazzy Electric Wheelchair. The Jazzy series includes the Jazzy Select, the Jazzy 1103 Ultra (which includes a seat lifting mechanism), the Jazzy 1121 and others. The Jet and Jazzy series combined represent the most common type of electric wheelchair on the market today. Pride’s third line is the Quantum series, which is tailored to high-end rehab and specialty needs patients.

Invacare is the overall industry leader for home medical products, which include everything from canes and walkers to home oxygen products to electric wheelchairs and mobility scooters. When it comes to just power mobility products, they are probably behind Pride Mobility when it comes to market saturation.

Invacare is responsible for popular Pronto series of electric wheelchairs. The Pronto series includes the Pronto M50, the Pronto M51 the Pronto M61 and more. The Invacare Pronto series is well known for its durability. One nice thing about choosing an Invacare for your power mobility needs is that you will have nearly 15,000 independent medical equipment suppliers throughout the company that can assist you if you need to order parts or accessories.

The third most common brand name is Hoveround. Through its branding efforts, the company has made the name Hoveround synonymous with powered mobility equipment. Some people refer to electric wheelchairs as Hoverounds regardless of the brand. It is similar to how people often refer to tissue paper as Kleenex or soda pop as Coke.

Hoveround chairs are only available through the Hoveround Corporation. Although the company offers outstanding customer service and is one of the largest mobility providers in the United States, it can sometimes be difficult to get parts or accessories since you have to order direct.

How Much Does a Power Wheelchair Cost?

Once your doctor has completed all of the necessary paperwork for an electric wheelchair and the medical equipment supply company has agreed that you are a qualifying candidate, it’s time to work out any financial obligations. The medical equipment supply company you work with will submit your claim to Medicare for reimbursement.

No matter where you reside in the United States, Medicare should pay 80 percent of the allowable price for your electric wheelchair once you are approved. The allowable price will vary by state, chair type and accessories ordered. The average electric wheelchair will have a price of $4800-$6500.

If you have a secondary or supplemental insurance to Medicare, it may pay the additional 20% co-payment, depending on if they are contracted with the medical supply company you have chosen to work with and if they have coverage for power operated vehicles. Not all secondary or supplemental insurance companies will offer this benefit and some may not be contracted with the company you have chosen to provide your electric wheelchair.

If for some reason your co-payment is not covered by your secondary or supplemental insurance company, or you simply do not have supplemental insurance, you may be responsible to pay the co-payment at the time your electric wheelchair is delivered. Some larger companies like The Scooter Store offer non-interest payment plans to help you pay out your co-payment over time. Other companies will expect you to pay at delivery or they will not deliver it.

Depending on your income situation, some companies may be able to waive your co-payment. This is normally reserved only for households that fall below federal government poverty and income guidelines.

Medicare Requirements for Power Wheelchairs & Scooters

In October of 2005, Medicare began requiring any patient seeking an electric wheelchair or mobility scooter to have a face-to-face exam with a physician. This exam serves as an evaluation to ensure that the patient meets all of Medicare’s requirements for power mobility including electric wheelchairs and scooters. Most of the time, the patient has already met with a medical equipment supply company who will send over paperwork to the physician to be completed during the exam.

The paperwork will normally consist of some sort of mobility assessment evaluation form, a request for a detailed prescription from the physician and any other supporting documentation, which may include copies of the patient’s chart notes or a letter of medical necessity (LOMN). Since Medicare does not offer a standard set of electric wheelchair evaluation forms, paperwork may vary by medical equipment supply company.

During the face-to-face exam for powered mobility, the physician will address the following nine required items with the patient to determine eligibility for an electric wheelchair and document his or her answers on the paperwork provided or into the patient’s chart notes:

1. Does the patient have a limitation that significantly impairs his or her ability to participate in one or more mobility related activities of daily living (MRADLs) in the home?
2. Are there other conditions that limit the patient’s ability to participate in MRADLs at home?
3. Is there another way to compensate for the patient’s limitation in the home? For example, could a caregiver assist the patient or could some sort of therapy work instead of the need for an electric wheelchair?
4. Is the patient capable and willing to operate an electric wheelchair safely?
5. Can a cane or walker be used instead of an electric wheelchair? If not, why?
6. Does the patient’s home support the use of an electric wheelchair?
7. Can the patient’s mobility limitation be resolved with a manual wheelchair? If not, why?
8. Can the patient’s mobility limitation be resolved with a mobility scooter (three wheel style)?
9. Does the patient need the additional features of an electric wheelchair to safely conduct his or her daily living activities?

Some physicians will complete the paperwork during the exam while others will make notes and complete the paperwork at some point after the appointment is over. Medicare allows 45 days after the completion of the exam for the paperwork, prescription and any supporting documentation to be completed and returned to the medical equipment company. If a physician does not get the paperwork completed during this 45-day window, the patient will be required to schedule an additional exam to be evaluated again and the 45-day time limit will start over.

Power Wheelchair & Scooter Buying Tips: How to Choose a Medical Equipment Company

Once a person has met the initial eligibility guidelines for an electric wheelchair, it’s time to visit a medical equipment company to initiate the Medicare process and paperwork. There are many companies out there that can assist you in getting an electric wheelchair. There are large companies like The Scooter Store and Hoveround and there are thousands of small independent medical equipment suppliers throughout the country.

If you don’t know where to go to get an electric wheelchair, it’s a good practice to start by asking people for a referral. There’s a good chance you or someone close to you knows someone else who already has an electric wheelchair. Consider contacting companies that you hear good things about and stay away from companies that you hear anything bad about. If you can’t get a referral from someone you know, you can check the yellow pages, contact your physician and ask for a company he or she recommends or contact your local senior center or AARP office.

Below are a few things you should consider when choosing the medical equipment company that will assist you in getting an electric wheelchair:

1. How long have they been in business?
2. Do they conduct service and repairs on the equipment they provide after the sale?
3. What happens if Medicare denies your claim? Will they bill you for your electric wheelchair or repossess it?
4. What secondary insurances do they work with and do they offer payment plans for any out of pocket expenses you may incur?

 

There are pros and cons to using a large, national company versus using a local medical equipment store. Local companies can usually assist you with a wide variety of medical equipment needs including mobility, bathroom safety, home oxygen and more while the larger companies tend to focus more on just electric wheelchairs and scooters.  The larger companies normally provide nationwide, in-home service and repairs while the local companies are usually restricted to working on your electric wheelchair in your home city.

The two largest companies in the United States that offer electric wheelchairs through Medicare are The Scooter Store and Hoveround. Both companies are well established and offer service after the sale. The Scooter Store is well known for its guarantee that it will give you your electric wheelchair if Medicare does indeed deny the claim. This is an excellent peace of mind guarantee.

Whether you choose a local medical supply company or a nationwide company like The Scooter Store, make sure you fully understand all of their policies and procedures before you get started.

Power Wheelchair & Scooter Price Reimbursement Bumped by Medicare

The Centers for Medicare/Medicaid Services (CMS) today announced that it has bumped the reimbursement rate for power mobility devices (power wheelchairs and scooters). CMS increased payments for the K0823 class of chairs/scooters by $75.20 and and the K0825 class by $277.60.

 

This bump in prices was an adjustment to the November changes to power wheelchair and electric scooter reimbursement changes. It was then that CMS lowered reimbursement rates by as much as 38 percent. The increases today are in response to errors in the original calculations.

Industry watchers say that the bump in rate is still not enough. Most motorized wheelchair and electric scooter providers were hoping for significantly higher adjustments.

CMS announced that the changes will be retroactive back to the original changes in reimbursement, which took place Nov. 15th. Providers can request additional revenue for any claims paid during that time.



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