CELESTE CHAPOUTOT
Rand Pharmacy

Medicare Reimbursements

Due to recent changes in Medicare reimbursements, I will address some of the requirements to receive equipment as well as what rentals really mean.

Most Medicare rental items are rented on a month to month basis for up to 15 months. If the patient goes into a nursing home or on hospice, the surgical store who provided the equipment needs to be contacted, as Medicare only pays for the rental of equipment in the patient's home or while they are in an assisted living.

If a person goes on Hospice, the Hospice provider is responsible for suppling the equipment or supplies. They are being paid by Medicare and the Supply store will not be able to bill Medicare for the equipment, as the Hospice provider will be billing Medicare. The Hospice provider should contact the medical supply company to pick up the equipment or contract with them for the rental of such equipment. This equipment is a rental and not the property of the patient, UNLESS the patient has rented the equipment for more than 10 months, signed an agreement with the rental medical company that they want to own the equipment, which at that time Medicare will cover the equipment to the13 month on a rental, and then the equipment becomes the property of the patient who now owns the equipment and is responsible for any repairs if needed.

If the patient goes into the nursing home, the nursing home provides the equipment.
There are many different payment programs and reasons that a patient goes into the nursing home. If they are totally private pay and Medicare or Medicaid is not paying for their stay, then the nursing home is considered their home. Each case needs to be reviewed with the medical supply company as to handle transfer of equipment or pick up of such.

All puchase items through Medicare such as: canes, walkers, commodes, diabetic supplies, wheelchair cushions and overlay gel mattress are the property of the patient and do not need to be returned. ONLY rental items need to be returned.

WHEELCHAIRS: The requirements is that the patient is non-ambulatory, chair or bed bound and must be stated in the doctor's notes in addition to the certificate of medical necessity.

AIR MATTRESS: Must have a stage 3 wound on the trunk of the body or multiple stage 2 and must be noted in the doctor's notes.

OVERLAY MATTRESS: A mattress which goes on top of the patient's bed who is partially paralyzed, OR has a stage 1 on the trunk of the body and has one of the following conditions: diabetes, circulatory problem or incontinence.

Most all equipment has a five year rule. This means that Medicare will cover a new item after this period, such as canes, walkers, glucose monitors, etc. All of these items do need a new prescription.

Any questions about reimbursement or qualifications for a product, contact CELESTE CHAPOUTOT AT 732-245-0143.
Look for the next issue on MEDICARE PART D....our pharmacist is now booking seminars on this topic in Ocean County. If your club would like to have this lecture, contact Bill Shady at Rand's Pharmacy at 732-255-3211.