Author Topic: Billing Medicare for Wheelchair  (Read 2521 times)

DonK

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Billing Medicare for Wheelchair
« on: July 31, 2013, 06:07:14 PM »
I am with a small home infusion company. We have just started offering a limited line of DME products. I need to bill Medicare for a wheelchair. HCPCS code is K0001. I think it has to billed as a rental, but I cannot seem to find our how many months it can be billed until it is considered a purchase. CMS website is not extremely helpful in answering my question.

ANY help would be appreciated!

Merry

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Re: Billing Medicare for Wheelchair
« Reply #1 on: August 05, 2013, 09:27:20 PM »
Are you a company who is in a geographical area regarding competitive bidding process for DME  Medicare?  Please check this out as you will not be able to sell DME to Medicare beneficiaries and get reimbursed by Medicare.
If the physician documents with a CMN (Certificate of Medical Necessity) that the patient will need this equipment for a long period of time, it can be rented to the patient. Also, you need to understand as does the patient, that wheelchairs and/or scooters are ONLY approved if the patient needs this equipment at HOME. A wheelchair for "getting around outside" in not a Medicare covered benefit. I assume you are talking about a regular wheelchair and not a motorized or customized.
Rentals are usually paid by Medicare for 10 months. If the patient decides to purchase , Medicare will make 3 additional rental payments (total 13). If the patient continues to rent, Medicare will pay a total of 15 rental payments. You, the supplier are responsible for maintenance of the wheelchair.

Please be careful. The DME industry is fraught with fraud and the government is really going after DME dealers.

So, be sure you have all the information that you need from the prescribing physician and be sure that it is needed for the home..for instance, in a case where a walker or cane would not be suitable for the patient. The patient also must have the room to use the wheelchair with no barriers.  In other words, they need to be safe.

I would examine your business to see if you would make enough money selling these as you will be open for scrutiny from Medicare. In no way am I saying that you are doing anything wrong. Just be very careful. Of course, you must be certified by Medicare to sell DME.

DonK

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Re: Billing Medicare for Wheelchair
« Reply #2 on: August 16, 2013, 04:41:22 PM »
Thanks for the info. You have answered my question and given much to think about.

Thanks again!!

Medical Billing Forum

Re: Billing Medicare for Wheelchair
« Reply #2 on: August 16, 2013, 04:41:22 PM »