Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).
The different benefits of the traditional Medicare
- Medicare Part A benefits cover hospital stays, home health care and hospice services.
- Medicare Part B benefits cover physician visits, laboratory tests, ambulance services and home medical equipment.
- While oftentimes you do not have to pay a monthly fee to have Part A benefits (you only have to pay money when you use the services), the Part B program requires a monthly premium to stay enrolled (even if you do not use the services). In 2014 that premium will be $104.90 per month (but could be less) depending on your income. Typically, this amount will be taken from your Social Security check.
- Medicare Part D offers optional program benefits that cover prescription drugs.
- For more information about your benefits or making coverage decisions, you can visit the official website for Medicare benefits at www.medicare.gov.
Durable Medical Equipment (DME) Defined
In order for any item to be covered under Medicare, it typically has to meet the test of durability. Medicare will pay for medical equipment when the item:
- Withstands repeated use (which excludes many disposable items such as underpads)
- Is used for a medical purpose (meaning there is an underlying condition which the item should improve)
- Is useless in the absence of illness or injury (which excludes any item that is preventive in nature such as bathroom safety items used to prevent injuries)
- Used in the home (which excludes all items that are needed only when leaving the confines of the home setting)
The role of the physician with respect to home medical equipment:
- Every item billed to Medicare requires a physician’s order or a special form called a Certificate of Medical Necessity (CMN), and sometimes additional documentation will be required such as copies of office visit notes from prior visits with your physician or healthcare provider or copies of test results relevant to the prescription of your medical equipment.
- Nurse Practitioners, Physician Assistants, Interns, Residents and Clinical Nurse Specialists can also order medical equipment and sign CMNs when they are treating you.
- All physicians and healthcare providers have the right to refuse to complete documentation for equipment they did not order, so make sure you consult with your physician or healthcare provider about your need for medical equipment or supplies before requesting an item from a supplier.
- For every new item prescribed by your physician or healthcare provider, you should have a recent office visit that documents the reasons for ordering the equipment and products. Many items will now require you to have an in-person office visit with your doctor or healthcare provider to discuss the need and justification for the prescription of medical equipment before a supplier can fill those orders.
Prescriptions before Delivery:
For some items, Medicare requires your supplier to have completed documentation (which is more than just a call-in order or a prescription from your doctor or healthcare provider) before they can deliver these items to you:
- Decubitus care (wheelchair cushions, pressure-relieving surfaces placed on a hospital bed and air-fluidized beds)
- Seat lift mechanisms
- TENS Units (for pain management)
- Power Operated Vehicles/Scooters
- Electric or Power Wheelchairs and related options and accessories
- Negative Pressure Wound Therapy (wound vacs)
- The list of items that require an office visit and written order before delivery has been expanded due to new provisions of the Affordable Care Act to include all items that cost more than $1000, and commonly prescribed items such as oxygen, hospital beds, wheelchairs and more. There are over 150 products across multiple product categories that are affected. Your supplier will be able to tell you if the item ordered by your doctor or healthcare provider is subject to these additional requirements.
- Your supplier cannot deliver these products to you without a written order from your doctor or healthcare provider, nor can they get the documentation at a later date because if they do, Medicare can never make payment for those products to you or your supplier. So please be patient with your supplier while they collect the required documentation from your physician or healthcare provider.
What does Medicare cover?
There are a few policies regarding Medicare covered items:
- Purchase it outright, then the equipment belongs to you,
- Rent it continuously until it is no longer needed, or
- Consider it a “capped” rental in which Medicare will rent the item for a total of 13 months and consider the item purchased after having made 13 payments.
- Medicare will not allow you to purchase these items outright (even if you think you will need it for a long period of time).
- This is to allow you to spread out your coinsurance instead of paying in one lump sum.
- It also protects the Medicare program from paying too much should your needs change earlier than expected.
- If you have oxygen therapy, Medicare will make rental payments for a total of 36 months during which time this fee covers all service and accessories.
- Beyond the 36 months (for a period of two additional years), Medicare will limit payments to a small fee for monthly gas or liquid contents, where applicable, and a limited service fee to check the equipment every six months.
- After an item has been purchased for you, you will be responsible for calling your supplier anytime that item needs to be serviced or repaired. When necessary, Medicare will pay for a portion of repairs, labor, replacement parts, and for temporary loaner equipment to use during the time your product is in for servicing. All of this is contingent on the fact that you still need the item at the time of repair and continue to meet Medicare’s coverage criteria for the item being repaired.
What is “Competitive Bidding”?
In many parts of the country, a new program called Competitive Bidding will require you to obtain certain medical equipment from specific, Medicare-contracted suppliers in order for Medicare to pay. Not all products are subject to competitive bidding in the same area. If you are located in a city where the program is in effect, you will need to obtain some or all of the following items from a contracted supplier:
- Oxygen, oxygen equipment, and supplies
- Standard power wheelchairs, scooters, and related accessories
- Enteral nutrition, equipment, and supplies
- Continuous Positive Airway Pressure (CPAP) devices and Respiratory Assist Devices (RADs), and related supplies and accessories
- Hospital beds and related accessories
- Walkers and related accessories
- Support surfaces (Group 1 and Group 2 mattresses and overlays)
- Manual Wheelchairs and accessories
- Mail-order and direct delivery of diabetic supplies
- Home infusion therapy including insulin pumps and supplies
- TENS Units and supplies
- Patient Lifts
- Seat Lifts
- Negative Pressure Wound Therapy Devices and related supplies and accessories
Competitive Bidding areas are designated based on the zip code of your permanent residence on file with Social Security. To find out if your zip code is affected by Competitive Bidding, call 1-800-MEDICARE (1-800-4227). You may also visit Medicare.gov and lookup suppliers in your area by zip code (a notice will appear if your area is subject to Competitive Bidding). If medical equipment is marked with an orange star, it will need to be provided by a contracted supplier (also marked with an orange star). Throughout this guide, products that are potentially impacted by the competitive bidding program will be designated with a double asterisk **. Your provider can assist you with answering your questions about competitive bidding and can address whether or not they have been contracted to provide the services you need if subject to competitive bid.
- Aging Parents – http://www.aging-parents-and-elder-care.com/
- Allergy and Asthma Network/Mothers of Asthmatics – http://www.aanma.org
- ALS Association of America (ALSA) – http://www.alsa.org
- American Association for Respiratory Care – http://www.AARC.org
- American Cancer Society – http://www.cancer.org/
- American College of Allergy, Asthma, and Immunology – http://www.acaai.org/
- American Heart Association – http://www.americanheart.org/
- American Lung Association – http://www.lung.org/
- American Red Cross – http://www.redcross.org/
- American Sleep Apnea Association – http://www.sleepapnea.org/
- Arthritis Foundation – http://www.arthritis.org/
- Asthma and Allergy Foundation of America – http://www.aafa.org
- Brain Injury Association of America – http://www.biausa.org/
- Center for Neurologic Study – http://www.cnsonline.org
- Forbes Norris MDA/ALS Research Center – http://www.cpmc.org
- Les Turner ALS Foundation – http://www.lesturnerals.org
- March of Dimes – http://www.marchofdimes.com/
- Mesothelioma Group – http://www.mesotheliomagroup.com/
- Mesothelioma Veterans Center – https://www.mesotheliomaveterans.org/
- Muscular Dystrophy Association – http://mda.org/
- National Asthma Education and Prevention Program – http://www.nhlbi.nih.gov/health-pro/resources/lung/naci/asthma-info/naepp.htm
- National Family Caregivers Association (NFCA) – http://www.nfcacares.org/
- National Home Oxygen Patient’s Association – http://www.homeoxygen.org/about
- National Jewish Medical and Research Center – Pulmonary Disease – http://www.nationaljewish.org/
- National Multiple Sclerosis Society – http://www.nationalmssociety.org/
- People for Quality Care – http://www.peopleforqualitycare.org
- Spina Bifida – http://www.sbaa.org/
- The Pulmonary Paper – http://www.pulmonarypaper.org/
- Understanding an Asthma Attack – http://www.healthline.com/asthma/anatomy-animations
- United Ostomy Association – http://www.ostomy.org/
- United States COPD Coalition – http://www.uscopdcoalition.org
- Visiting Nurses Association – http://www.vnaa.org/
What Sleep Apnea?
Sleep apnea is very common condition that causes a disruption of breathing while asleep. It is a deceiving sleep disorder – 90% of people who have sleep apnea don’t know that they have it! Although episodes of choking or gasping for air might occur hundreds of times throughout the night, you may not have any recollection of struggling for breath.
Usually it is the bed partner who first notices that the person is struggling to breathe. If left untreated, this common disorder can be life-threatening.
What happens when you have an episode of sleep apnea?
When you stop breathing during sleep due to sleep apnea, the balance of oxygen and carbon dioxide in the blood is upset. This imbalance stimulates the brain to restart the breathing process. The brain signals you to wake up so that the muscles of the tongue and throat can increase the size of the airway. Then, carbon dioxide can escape, and oxygen can enter the airway. These waking episodes are necessary to restart breathing (and to save your life), and you may not remember them, but they do disrupt your sleep and cause daytime exhaustion.
What is Obstructive Sleep Apnea (OSA)?
OSA is the most common type of sleep apnea. It is caused by a breathing obstruction, which stops the air flow in the nose and mouth.
What is Central Sleep Apnea (CSA)?
Central sleep apnea (CSA), less common than OSA, is a central nervous system disorder that occurs when the brain signal telling the body to breathe is delayed. CSA can be caused by disease or injury involving the brainstem, such as a stroke, a brain tumor, a viral brain infection, or a chronic respiratory disease. People with CSA seldom snore. However, while the causes of apnea are different in CSA and OSA, the symptoms and results are much the same – a deprivation of oxygen and poor sleep. The treatments for CSA include medications that stimulate the need to breathe and administration of oxygen.
Medoville offers a number of Positive Airway Pressure equipment to help their patients treat their sleep disordered breathing. Please feel free to contact our licensed clinicians to provide you with the expert education and support you need.
What is a Bi-PAP?
A device that provides ventilation for patients by delivering air to the lungs at two levels of pressure, either cyclically in an anaesthetized patient or triggered by the patient’s attempts at breathing when awake.
What is a CPAP?
For those with sleep apnea, relief usually comes with continuous positive airway pressure (CPAP). Continuous Positive Airway Pressure (CPAP) devices deliver a prescribed level of positive pressure non-invasively to the upper airway for the treatment of sleep apnea. Extremely easy to use, CPAPs come with different features such as ramping to allow comfortable adjustment to the pressure; software to capture specific usage and breathing events; and automated altitude adjustment. Accessories, such as nasal interface applications and humidification devices are provided to afford maximum comfort to ensure patient compliance.
What is an APAP?
APAP stands for Automatic Positive Airway Pressure and relies on the same basic principles as a CPAP (continuous positive airway pressure) machine. Similar to the CPAP devices, APAP machines are a non-invasive treatment for sleep apnea that deliver pressurized air, via a mask, to keep your airways free of obstructions as you sleep. The air pressure delivered from the machines acts as a splint, keeping your throat from collapsing in on itself so that you can breathe freely through the night without any apnea events.
How often should I change my CPAP supplies?
CPAP Supply Schedule
**NOTE: It is important to replace your items regularly to maintain your CPAP equipment. You will be receiving an email or phone call from our replenishment department every month as a gentle reminder. If you have any questions about your replenishment supplies or CPAP cleaning instructions, please do not hesitate to contact Medoville at 888-630-2334.
How should I clean my CPAP equipment?
- Use water and gentle soap. The soap must not be moisturizing contain lotion. Agitate for about 5 minutes.
- Rinse well with warm water and allow to completely dry.
- Refrain from using alcohol-based products.
- The black filter may be rinsed with water and blotted dry. This filter may be replaced twice a year.
- The white filter is disposable and can be replaced twice a month. It is not to be washed.
- The PAP machine may be wiped with a damp cloth.
- Clean the items when you wake up for the day to allow for sufficient drying time.
Overview and Facts about Asthma
Asthma occurs when the airways in your lungs (bronchial tubes) become inflamed and constricted. The muscles of the bronchial walls tighten, and your airways produce extra mucus that blocks your airways. Signs and symptoms of asthma range from minor wheezing to life-threatening asthma attacks.
Asthma can’t be cured, but its symptoms can be controlled. Management includes avoiding asthma triggers and tracking your symptoms. You may need to regularly take long-term control medications to prevent flare-ups and short-term “rescue” medications to control symptoms once they start. Asthma that isn’t under control can cause missed school and work or reduced productivity due to symptoms. Because in most people asthma changes over time, you’ll need to work closely with your doctor to track your signs and symptoms and adjust your treatment as needed.
Asthma is common, affecting millions of adults and children. A growing number of people are diagnosed with the condition each year, but it isn’t clear why. A number of factors are thought to increase the chances of developing asthma. These include:
- A family history of asthma
- Frequent respiratory infections as a child
- Exposure to secondhand smoke
- Living in an urban area, especially if there’s a lot of air pollution
- Exposure to occupational triggers, such as chemicals used in farming, hairdressing and manufacturing Low birth weight
- Being overweight
This interactive asthma animation provides a comprehensive overview of asthma as a critical starting point for individuals and/or their loved ones. All information has been reviewed for medical accuracy by an MD. Click here to watch the video.
COPD Overview and Facts
Chronic obstructive pulmonary disease (COPD) refers to a group of lung diseases that block airflow and make it increasingly difficult for you to breathe.
Emphysema and chronic bronchitis are the two main conditions that make up COPD, but COPD can also refer to damage caused by chronic asthmatic bronchitis. In all cases, damage to your airways eventually interferes with the exchange of oxygen and carbon dioxide in your lungs.
COPD is a leading cause of death and illness worldwide. Most COPD is caused by long-term smoking and can be prevented by not smoking or quitting soon after you start. Damage to your lungs can’t be reversed, so treatment focuses on controlling symptoms and minimizing further damage.
Medoville offers nebulizers for children, teenagers and adults. Please feel free to contact our staff for more information, at 888-630-2334.
Changes medication from a liquid to a mist so that it can be more easily inhaled into the lungs. This is performed by breathing the medicated mist through a mouthpiece or mask attached to the nebulizer device, which is driven via a plastic tubing, attached to the compressor unit. The medications used in nebulizers help you by loosening the mucus in the lungs so it can be coughed out more easily, and by relaxing the airways so that more air can move in and out of the lungs. Nebulizer treatments take approximately 15 minutes to deliver the medication and are prescribed by your physician.
What is HIPAA?
HIPAA stands for the Health Insurance Portability and Accountability Act. The law was designed to protect the confidentiality and security of patients’ healthcare information. HIPAA provides patients with access to their medical records and more control over how their personal health information is used and disclosed.
Why is HIPAA important to me?
HIPAA protects the confidentiality of your personal health care information. Any information that your health care providers receive or create regarding your health, health history, treatment, and payment activities is confidential under HIPAA.
The law requires your health care providers to document the safeguards, policies, and procedures that will protect the privacy of your health care information. Under HIPAA, you have more control over the uses and disclosures of your health care information.
Our customers will receive an overview of our privacy policies. Customers can also request a Notice of Privacy Practices from Medoville Inc. If you have any questions or concerns about our privacy policies, please contact us.