Medicare +
Bellevue Healthcare
A Guide for Medicare Beneficiaries
We believe it is important you understand the billing process, reimbursement, and why purchasing your equipment directly can be the most cost effective solution.
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I. Medicare & Medical Equipment: What Are My Options
If you are an original Medicare beneficiary in need of medical equipment there are two options available to you to obtain the equipment you need:
1. Through Medicare
2. Direct Purchase – the simple and economical option.
The following sections will walk you through how to obtain your equipment through each option, their limitations, and the pros and cons of each option.
Original Medicare beneficiaries have the opportunity to obtain eligible medical equipment through Medicare. Depending on the type of equipment, Medicare may only provide the equipment as a rental. In this scenario, the rental equipment you will be provided with will be provided from available rental stock. Some inexpensive items are available for purchase or as a rental.
The charts below contains some of the most common equipment scenarios:
Routinely Purchased Items
Eligible inexpensive items like those listed in the chart above can be purchased directly and billed to Medicare for reimbursement afterwards. You will still need to obtain a prescription (dated before the day of purchase) and any other required documentation to submit your claim and secure coverage. Bellevue Healthcare can prepare and submit the claim on your behalf. See the Medicare Billing Process for more information.
Oxygen Equipment Rentals
Medicare oxygen equipment rentals are not on a 13 month capped cycle. Additionally, they require additional documentation during the rental cycle to continue billing. This includes follow-up visit notes and updated prescriptions. If you are a clinical referral, click here to view the Medicare guidelines and criteria documentation for oxygen.
No Coverage for Medicare Beneficiaries in Skilled Nursing Facilities and Hospice
Medicare will not cover equipment for original Medicare beneficiaries in a nursing home, skilled nursing facility, home health facility or hospice. Medicare expects that the facility will provide any equipment you may need. If you need equipment not available at your facility or hospice, purchasing directly is still an option. Bellevue Healthcare will work with you to ensure you are provided the equipment you need.
No Delays: Get the Equipment You Need When You Need It
No waiting for an appointment to obtain a prescription, physicians to send paperwork, or for prior authorization to be secured.
CHOICE: YOU DETERMINE THE EQUIPMENT YOU WANT OR NEED
If equipment is billed to Medicare, you are limited to available product lines that fit Medicare’s guidelines.
As a Medicare beneficiary, by choosing BHC you can receive exclusive pricing on our Medicare Value lines or opt to purchase any model you prefer. Buy with confidence knowing BHC offers delivery, setup, servicing, and a Price Match guarantee.
Cost Effective
Reduce total out-of-pocket cost by purchasing your equipment directly. Bellevue Healthcare offers competitive pricing for Medicare beneficiaries. Our Price Match Guarantee ensure we will not be beat on price.
New Equipment
Purchasing guarantees you will receive new equipment of your choice with the added peace of mind of a full manufacturer’s warranty coverage. In a Medicare rental you are provided eligible equipment from available stock and it will likely be previously used.
OPTION FOR MEDICARE BENEFICIARY IN FACILITIES OR HOSPICE
Medicare does not cover equipment if the beneficiary is in a nursing home, skilled nursing facility, home health facility or hospice.
Beneficiaries can either use the equipment provided by the facility OR purchase equipment at their own expense.
For Original Medicare beneficiaries who wish to submit a claim to Medicare for reimbursement, Bellevue Healthcare can submit a claim on your behalf for eligible equipment with qualifying documentation.
Please be aware the process of securing the necessary documentation for coverage can be lengthy.
After purchasing Medicare-eligible equipment, request that BHC submit a claim on your behalf. Our team will work with you to prepare the necessary documentation and submit your claim. The following outlines the steps involved.
I. Collect Your Documentation
- A prescription from your physician for the Medicare-eligible Equipment.
- A copy of your Medicare card (front and back).
- Client demographic sheet
- Required Documentation**
Signed copies of the following forms are also required:
- HIPPA Privacy Notice
- HIPPA Authorization Form
**Most product lines require additional documentation beyond a prescription in order to secure coverage. Our team will follow up with you and/or your physician about the required paperwork.
II. SUBMIT YOUR DOCUMENTATION
There are several ways you can provide Bellevue Healthcare with your documentation:
- SECURE ONLINE FORM: Click here and select “Medicare Insurance Orders” to use our online form to quickly and securely submit your documentation.
- IN-PERSON: Take or arrange for your prescription to be delivered to your local Bellevue Healthcare showroom.
- FAX: Request your physician submit your prescription and documentation to our secure fax line: 425.467.6661.
III. DOCUMENTATION REVIEW & PREPARATION
Once your documentation has been received, our Clinical Review team will review your documentation to ensure Medicare Criteria is met. We will work with your Physician and care provider(s) to obtain any additional documentation that is necessary to secure coverage.
IV. PROCESSING
Once complete, our team will submit your claim directly to Medicare. Medicare will respond to your claim in 6 to 8 weeks. If your claim is approved, you will receive reimbursement directly from Medicare. If Medicare requires additional documentation or rejects your claim you will be notified directly.
This process is for original Medicare beneficiaries with Medicare as their primary insurance. We can not submit claims for customers that have a HMO Medicare Advantage Plan as their primary coverage.
Definitions
Allowable Amount
Capped Rental
In a Capped Rental Medicare will pay a monthly rental fee for eligible equipment for a period not to exceed 13 months, after which the ownership of the equipment is transferred to the Medicare beneficiary and it becomes the beneficiary’s responsibility to arrange for any required equipment service or repair.
Charge Amount
The charge amount is the amount the provider (in this case Bellevue Healthcare) is charging to the insurance company. Usually because of contracted rates, the amount you charge an insurance company is not what you expect to be reimbursed for. The expected rate is the amount that you expect to receive as reimbursement.
Managed Medicare
Also referred to as “managed care plans” such as a health maintenance organization (HMO) plans, a Preferred Provider Organization (PPO) plans, or Point of Service (POS) plans. These plans are offered through private insurance companies and are not part of Original Medicare
Original Medicare
Refers Medicare Part A and Part B
Medicare Part C or Advantage Plans (like HMO or PPO) offered through private insurance companies are not part of Original Medicare.
Is Bellevue Healthcare an authorized Medicare provider?
Yes Bellevue Healthcare is an authorized Medicare provider.
Can Bellevue Healthcare bill Medicare for me?
Yes, Bellevue Healthcare can work with you and your physician to try to secure coverage. Coverage is not guaranteed.
What is a Capped Rental?
Medicare does not purchase most equipment directly, instead it provides equipment on a rental basis for 13 months. After the 13 month period is complete the rental is “capped” and ownership of the equipment is transferred to the Medicare beneficiary. Examples of equipment that are available as capped rentals include patient lifts, hospital beds, and manual wheelchairs.
How long will it take to receive my equipment?
If you purchase your equipment directly, your equipment will be available immediately. Bellevue Healthcare offers same day delivery within our service area on orders placed before 1:00pm.
If you are trying to secure coverage with Medicare, the process of obtaining the necessary documentation to secure coverage can take up to 6 weeks.