Med Emporium is an authorized Medicare provider and we are happy to assist you in obtaining reimbursement from Medicare for eligible medical equipment such as mobility scooters, lift chairs, rolling walkers and many other products. Items eligible for Medicare reimbursement are marked with this icon: Medicare Reimbursable +. Please note: Med Emporium does not provide courtesy billing for Medicaid. Med Emporium can bill Virginia Medicaid for all covered medical equipment and supplies with a physicians order.
How does Medicare “courtesy billing” work?
We understand that the process of submitting claims to Medicare can be difficult and time consuming. To help make the process easier, Med Emporium offers what is known as “courtesy billing”. This means that when you purchase an eligible product from Med Emporium and request at checkout that we courtesy bill Medicare, we handle all of the documentation required to submit a claim to Medicare on your behalf. If your claim is approved by Medicare, they will reimburse you directly for their portion of your claim.
Please note the following important information about Medicare courtesy billing:
- In order for us to courtesy bill, Medicare must be your primary insurance
- We are unable to courtesy bill Medicare if the beneficiary is in a nursing home, skilled nursing facility, home health facility or hospice facility as those facilities should be providing all necessary equipment and supplies.
- We are able to courtesy bill Medicare for beneficiaries in assisted living facilities; we will need to know that the beneficiary is in an assisted living facility because these claims are filed differently
How much will I be reimbursed through Medicare?
Medicare assigns every product that is eligible for reimbursement what is called an “allowable amount”. The allowable amount is the maximum amount that Medicare will consider as the total price of the item. The allowable amount for each item varies slightly by state. Medicare will pay 80% of the allowable amount or 80% of the cost of the item from Med Emporium, whichever is less. The other 20%, or copay, is the beneficiary’s responsibility or you may have a secondary insurance that will pay your 20% copay. Med Emporium will file a claim with your secondary insurance once we receive a response from Medicare.
Because Med Emporium’s prices are generally well below the Medicare allowable amount for eligible products, your 20% copay will likely be less than what it would be if you purchased from a local medical equipment supplier. This could mean significant savings on your 20% copay. Here are allowable amounts for items commonly purchased at Med Emporium:
- Scooters for individuals weighing 300 lbs or less (HCPCS Code K0800):
The allowable is approximately $1,160.
- Scooters for individuals weighing 301 lbs to 450 lbs (HCPCS Code K0801):
The allowable is approximately $1,850.
- Scooters for individuals weighing 451 lbs to 600 lbs (HCPCS Code K0802):
The allowable is approximately $2,150.
- Lift Chair Mechanisms (HCPCS Code E0627):
The allowable range is between $250-$300.
Please note the following important information about Medicare reimbursement amounts:
- Any applicable deductibles must be met before Medicare will reimburse you for their portion of the allowable amount on an approved claim.
- While we can’t guarantee Medicare reimbursement, we can promise that we’ll work with you to ensure that claims will be filed accurately and completely.
How does the reimbursement process work?
After purchasing a Medicare-eligible product and requesting that Med Emporium bill Medicare on your behalf, we will work with you to complete the required documentation and submit your claim.
Here’s the basic process:
Step 1: We will ask you for the following information.
— The prescription from your physician for all Medicare eligible equipment. This prescription must have a date that is before the date your product is delivered.
— A copy of your Medicare Card, both front and back and copies of your other insurance cards.
— Your date of birth
— For lift chairs only, please have your physician fill out the Certificate of Medical Necessity (CMN) document, which we will provide. This document must be signed/dated within 30 days of the written RX date, and can be returned to Med Emporium by either the physician’s office or by you.
– For mobility scooters only, you will schedule a face-to-face Functional Mobility Examination with your physician. Full details of the process are provided in the Medicare packet which we will provide.
Step 2: Medicare will process your claim. Medicare has between 30-45 days to respond to you regarding your claim and if your claim is approved, you will receive reimbursement directly from Medicare.
Can you bill HMO Medicare Advantage Plans like Secure Horizons or Humana?
Med Emporium cannot provide courtesy billing for customers that have an HMO Medicare Advantage Plan as their primary coverage (such as Secure Horizons HMO or Humana HMO). An Advantage HMO is a Medicare replacement HMO program whose services have been enlisted to manage your Medicare coverage and benefits.
What is the reimbursement criteria for mobility scooters?
The beneficiary may qualify for reimbursement for a mobility scooter (also called power operated vehicles or POVs) if the following general criteria are met:
— The beneficiary must have a mobility limitation which prevents them from performing one or more mobility related activities of daily living in the home, including toileting, eating, bathing, and grooming.
— There cannot be other conditions that limit the beneficiary from performing mobility-related activities of daily living at home, such as significant impairments of cognition or judgment and/or vision. This only applies if these other conditions cannot be addressed through other means, including caregiver support.
— The beneficiary must demonstrate the capability and the willingness to consistently operate the device safely.
— A cane, walker, or manual wheelchair will not provide the necessary functional mobility for mobility related activities inside the home.
— The beneficiary’s environment must allow for use of the scooter in all areas where the mobility related activities of daily living are customarily performed.
— For a scooter, the beneficiary must have sufficient strength and postural stability to operate the scooter.
— Medicare will deny a scooter as not medically necessary when it is needed only for use outside the home. A scooter that is beneficial primarily in allowing the beneficiary to perform leisure or recreational activities will be denied as not medically necessary.
What is the reimbursement criteria for lift chairs?
Medicare only covers the seat-lift mechanism, but not the actual chair/furniture portion itself. The reimbursement amount is between $250-$300 depending on the state in which the beneficiary is located if the coverage criteria are met. A lift chair is considered medically necessary if all of the following coverage criteria are met:
— The beneficiary must have severe arthritis of the hip or knee, or have a severe neuromuscular disease.
— The seat lift mechanism must be a part of the physician’s course of treatment and be prescribed to effect improvement, or arrest or retard deterioration in the patient’s condition.
— The patient must be completely incapable of standing up from a regular armchair or any chair in their home.
— Once standing, the patient must have the ability to walk, even if a cane, walker or other assistance is required. Medicare will not cover this item if the beneficiary has a wheelchair, scooter, or power wheelchair on file.
— By Medicare standards, the fact that a beneficiary has difficulty or is even incapable of getting up from a chair, particularly a low chair is not sufficient justification for a seat lift mechanism. Almost all beneficiaries who are capable of ambulating can get out of an ordinary chair, if the seat height is appropriate and the chair has arms.
— Medicare requires that the physician ordering the seat lift mechanism must be the attending physician or a consulting physician for the disease or condition resulting in the need for a seat lift.
What is the reimbursement criteria for wheelchair cushions?
For wheelchair cushions, the wheelchair for which the cushion will be used must already be on file with Medicare. When courtesy billing for the corresponding cushion, Medicare requires Med Emporium to submit the manufacturer, model and the date of purchase of the wheelchair on file. If no wheelchair is on file with Medicare, a cushion and wheelchair can be billed at the same time. The beneficiary must also either have a current pressure sore or have a previous history of a pressure sore on record due to the fact that Medicare will not cover any preventative items. Documentation of positioning requirements and any other risk factors will also be taken into consideration and should be submitted to Med Emporium with the prescription.
Can Med Emporium bill Medicare for a manual wheelchair, hospital bed, or patient lift?
Manual Wheelchairs are products that can be purchased by Medicare. If you choose to purchase a wheelchair from Med Emporium, we will be happy to file directly to Medicare. You or your secondary insurance would be responsible for the 20% co-insurance.
All manual wheelchairs, hospital beds and patient lifts are considered rental items. They require a monthly copay of 20% of the monthly rental amount. After 13 months of continuous rental, the item is then “purchased” for the beneficiary and no additional copay is required.
Can Med Emporium bill Medicaid for my items?
Yes, Med Emporium can bill Medicaid for covered products?
Additional Information Required by Medicare
Warranty Information (Medicare requires that we provide this information)
Every product sold by our company carries a warranty which can range from 6 months to more than 5 years. Med Emporium honors all manufacturer warranties, and will provide replacement parts, free of charge, for Medicare-covered equipment that is under warranty. In addition, an owner’s manual with warranty information will be provided to beneficiaries for all equipment where this manual is available.
Medicare Capped Rental (Medicare requires that we provide this information)
Capped Rental Items are items where Medicare will pay a monthly rental fee for a period not to exceed 13 months, after which the ownership of the equipment is transferred to the Medicare beneficiary and it is the beneficiary’s responsibility to arrange for any required equipment service or repair. Examples of this type of equipment include hospital beds, alternating pressure pads, nebulizers, patient lifts and trapeze bars.