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Medicare Coverage Criteria

Commonly Used Terms / Abbreviations

  • Subscriber - The individual who is the policy holder.

  • Co-Insurance - The amount that the patient is responsible to pay, typically a percentage of the allowed amount.

  • Deductible - The amount that the patient must pay before the insurance policy will pay.

  • Allowable - The amount that the insurance company will pay for a service/product.

  • DME - Durable Medical Equipment.  Items that are used typically within a home environment to assist a person with a medical condition.

  • HCPC - Health Care Procedure Code.  Every item of medical equipment is assigned a code to identify the product being billed to the insurer.

  • DX or ICD9 - Diagnosis Codes.  Every medical condition is assigned a specific numeric code.  This code must be included on claims submitted to Insurance payors to identify the condition necessitating the equipment or supplies provided.

  • Medical Necessity - Documentation of the medical condition requiring the supplies or equipment.  This may take the form of medical records, office visit notes, therapy evaluations, x-rays, lab reports or other documents.  Just because your physician prescribes an item for you, may not necessarily mean that the item is medically necessary for the treatment/management of your condition.

  • Capped Rental - Medicare's requirement that some items of DME, (such as wheelchairs, hospital beds, and CPAP machines) be provided on a rental basis for 13 months.  At the end of the 13 months, the title of the equipment is then transferred to the patient and the equipment becomes their property.  The patient is then responsible for arranging for any maintenance or service that is required.

  • CMN - Certificate of Medical Necessity.  A CMN is completed by your physician to document the medical necessity of the equipment being ordered.

  • ABN - Advanced Beneficiary Notice.  This notice is provided to a customer if Relieve Medical Supply believes that your insurance may not cover a specific item for a specific reason.  This form may also be used if Relieve Medical Supply provides an item that is considered an "upgraded" item instead of the standard item deemed necessary by your insurance.

  • Participating Providers - The provider has a contract with an Insurance payor and accepts their allowable to provide services to the payor's subscribers.

  • EOB - Explanation of Benefits.  This is a document provided by the Insurance payor that details the claim filed.  It will include the billed amount, the allowed amount, any co-insurance amount to be paid by the patient, and any non-covered charges.

Medicare Non-Covered Items

The following items are not considered Medical Equipment and/or are considered Convenience Items for personal use:

  • Bath Seats or Stools
  • Raised Toilet Seats
  • Grab Bars
  • Telephone Alert Systems / Emergency Contact Systems
  • Electric Air Cleaners / Air Purifiers
  • Incontinence Supplies - Briefs / Pads
  • Automatic Blood Pressure Monitors
Contact

Information

11490 Hanson Blvd. N.W.
Coon Rapids, MN 55433
Map & Directions »

Contact No. 763-780-3002
Fax No. 763-780-3008
Email info@relievemedical.com
Business Hours:
Mon - Fri    9am - 5:30pm
Sat & Sun    Closed
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