Medicare Face-to-Face Appointment for Durable Medical Equipment
When you choose a Durable Medical Equipment supplier, you want to make sure that getting your equipment is as seamless as possible. Durable Medical Equipment (DME) is any equipment that provides therapeutic benefits to a patient in need because of certain medical conditions and/or illnesses. Sometimes, patients urgently need this medical equipment. This is why it’s so important to understand Medicare’s DME requirements.
Aeroflow Healthcare is compliant with all Medicare requirements, including the most recent developments. Our dedicated team works tirelessly to stay up to date on the latest policies, so we can assure patients our medical equipment is provided legally and the process is as smooth as possible.
Medicare Face to Face Guidelines
The Affordable Care Act requires that a physician (MD, DO or DPM), physician assistant (PA), nurse practitioner, (NP) or clinical nurse specialist (CNS) has had a face-to-face examination with the beneficiary within six months of the written order for and delivery of select medical devices supplied by a DME.
The patient will come in and see the physician for an exam. The physician will, only after seeing the patient, write the order for the device.
Figuring out which devices require a face-to-face examination can sometimes be confusing for the patient. That’s why we make sure we remain apprised of any changes that occur where this rule is concerned. Here are just a few common DME needs that may require an exam.
Nebulizers
Nebulizers commonly treat conditions that can cause difficulty with breathing, such as asthma. They atomize liquid medicine into an inhalable form, making it easier to administer than oral medicine, particularly for infants. They are available in electric or battery-operated versions, and in different sizes. Medicare requires you to get a nebulizer machine through a Medicare-approved supplier, like us.
Ventilators
Some people will need a machine that supports breathing. Ventilators are usually used in hospitals. Some people may need to use ventilators long term or for the rest of their lives. In these cases, they can be in the home, or in a long-term care facility. Ventilators offer volume and pressure support the treat a variety of conditions, while they can be invasive or noninvasive. Invasive treatments include the use of an endotracheal tube, while noninvasive therapy administrators ventilation support through a mask.
CPAP Machines
CPAP (continuous positive airway pressure) therapy is most commonly used to treat breathing problems. One of the most common conditions treated with a CPAP machine is obstructive sleep apnea (OSA). Sleep apnea is an incredibly common condition defined when the upper airway becomes blocked during sleep, causing airflow to become reduced or to stop completely. It can lead to many health issues, so this equipment is crucial for those who suffer this condition as the continuous air pressure prevents their airways from becoming blocked during sleep.
Power Mobility Devices (PMD)
Under the stipulations, power mobility devices, such as scooters, require a face-to-face examination with a physician before being approved. Medicare patients who want coverage for a PMD must have a temporary or permanent disability that impairs mobility. The rental or cost of purchasing a Power Mobility Device will be covered by Medicare Part B as long as it is used mainly in the home or their home facility. This does not mean it cannot be used outside the home, just that the primary use must be within the home.
Power Wheelchairs
A Face-to-Face visit is also required for some wheelchairs, including power wheelchairs and motorized wheelchairs. The distinction between a power wheelchair and a power mobility device is that the wheelchair is defined as being controlled by a joystick or an electronic device rather than a tiller. Generally, they are needed by those who cannot use a cane, walker, or standard manual wheelchair. They are easily controlled with the use of a joystick and can be maneuvered in tight spaces around the home to assist those with mobility issues.
Oxygen Therapy
Medicare will cover home oxygen therapy, but there are specific coverage requirements including a face-to-face doctor’s appointment. Supplemental oxygen therapy treats people with chronically low oxygen from conditions like COPD or cystic fibrosis. The face-to-face appointment must have the physician conduct an in-person examination and a document that records the proper medical expert evaluated the patient for a condition that needs a DME item.
Hospital Beds
Hospital beds offer patient comfort and mobility because caregivers can wheel them to different areas of the home. Some are even electric to provide patients with the option of easily changing positions during the day when mobility issues and other conditions place them on bed rest. Medicare Part B can help pay for a hospital bed if it is determined to be “medically necessary” as prescribed by a doctor.
Urinary Catheters
Broadly, Medicare will cover up to 200 intermittent catheters a month.
Durable Medical Equipment & Medicare Part B
Typically, Medicare Part B covers medical equipment if your doctor determines it to be medically necessary. The DME items above and many others do require a face-to-face consultation to determine medical necessity. Medicare Part B will typically pick up 80% of the cost, and you will have a coinsurance of 20%.
Our team works with you and your insurance to ensure that the proper appointments are made. Because proper documentation is vital for Medicare coverage, we file all proper documentation. Also, we make sure our team is knowledgeable and diligent in following through with your insurance so that out of pocket costs are minimal and there are no surprises. At Aeroflow, we’re more than happy to guide you through the insurance process.
