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Medicare Diabetic Supplies Diabetic Diet Plan

Medicare DMEPOS

DMEPOS is the Medicare acronym meaning durable medical equipment, prosthetics, orthotics, and supplies, and refers to the part of Medicare that covers all billable, tangible items. This is the part of Medicare that covers your diabetic supplies, canes, walkers, oxygen, CPAP machine, nebulizer and nebulizer medicine, seat lift mechanism, wheel chair and power scooter, intraocular lens when you have cataract surgery, custom orthotics, and prostheses when you need medically necessary replacement. It is also the part of Medicare that covers shots, injections, and intravenous medications when delivered as part of a doctor's treatment in an office or outpatient setting.

In Medicare language, this is DME (durable medical equipment), and it has its own set of rules and regulations for coverage under Part B of Medicare. More often than not, you may never need to think about the benefit or worry about coverage for your Medicare medical supplies. Nevertheless, your Medicare DME experience often depends on your supplier, how well they grasp the rules and regulations, and their understanding of payment and billing guidelines as they apply to different categories and kinds of durable medical equipment. In order to help ensure that you get the most out of your benefits, this article will explain some of the basics so that you know your way around the territory of DME coverage.

Essential DME Covered and Non-Covered Guide Posts

One of the most important points to understand about coverage is all DME, whether diabetic medical supplies, other rental equipment or items that you purchase, must be medically necessary and prescribed by a physician. Second, the provider from whom you receive supplies must be a Medicare supplier. That means it must be enrolled in the Medicare program and must submit claims to Medicare on your behalf. If you go to a supplier who does not have a Medicare supplier number, Medicare may not pay, and you should be prepared to pay the charges out of your own pocket.

You can find a directory of suppliers on the Medicare.gov website by using the DME Medicare Supplier Directory. However, it is important to understand that there are two kinds of enrolled suppliers, suppliers who "participate" with Medicare and suppliers who do not. A supplier who participates with Medicare accepts assignment, which means that it accepts the Medicare approved amount as payment in full for all Medicare covered DMEPOS items. That means you would pay only the required 20 percent coinsurance and any remaining Part B deductible. Non-participating suppliers do not accept assignment, and this means that that there is really no limit to what they can charge, and you would be obligated to pay the difference in cost between their price and the Medicare approved amount.

When choosing a supplier, be sure to ask if they are enrolled in the Medicare program and whether or not they accept assignment. Remember, if they are a Medicare provider, they must submit claims on your behalf. A supplier who tells you that they don't submit claims, but that you can submit your own and that Medicare will pay is either uninformed or not being honest. You should walk away and find another supplier.

Capped Rental

This is a category of DME rental items that includes wheel chairs, power operated vehicles, CPAP machines, nebulizers, hospital beds, patient lifts, and oxygen and oxygen supplies. With all Medicare DME rental equipment, you have the option to either purchase or rent. Capped rental means that if you choose to rent, Medicare pays for a certain period of time, and then title and ownership transfer to you. In order to understand Capped Rental, you must understand that the rules governing this particular DME category changed after January 1, 2006.

Before January 1, 2006

Medicare would make maximum of 15 rental payments after which the supplier would own the equipment and be responsible for all maintenance and servicing for the lifetime of the equipment.

After January 1, 2006

Medicare would make a maximum of 13 rental payments after which you own the equipment. Again, the supplier would be responsible for maintenance, servicing, and repairs.

The useful lifetime of equipment is generally considered to be 5 years, after which Medicare is able to pay for new equipment provided it is medically necessary.

Capped Rental and Oxygen

Capped rental works a little differently with oxygen. The capped rental period for oxygen and supplies is 36 months, and the suppler retains ownership of the equipment. However, after the 36 months the supplier is responsible for keeping your oxygen supplies in good working order.

DME Returns

It is also helpful to know that you can return any Medicare covered equipment and medical supplies if they are not appropriate for you. Medicare stresses that when you return supplies that you get a pick up slip. A pick-up slip is your receipt and proof of return. In the event that a supplier, by design or mistake, continues to bill Medicare for returned supplies, the pick-up slip facilitates correction of the error. A pick-up slip also makes it much easier for you to resume the rental of item that you may have returned but now have renewed need of. You would, in a sense, pick up where you left off.

Diabetic Medical Supplies

Medicare Part B offers coverage for the following diabetic supplies: test strips, lancets, the spring powered device for the lancets, monitor, and blood glucose control solution. Medicare only covers insulin when it is used in an insulin pump. Otherwise, insulin, needles, and injection supplies are covered by the Medicare, Part D prescription drug plans. In order to get diabetic supplies, you will need a prescription, and in order for Medicare to pay, the pharmacy must be enrolled in the Medicare program.

One point to keep in mind especially in regard to diabetic testing strips, is that pharmacies are required to have on file documentation that shows the amount of supplies you need is consistent with your condition. In some cases, a pharmacy may ask you for a testing log as proof of your use and need of diabetic medical supplies. However, in circumstances where you may not have a testing log, that information can also be provided by your physician.

DME equipment, rental, and supply is a large and sometimes complicated area of coverage. This article lays out some of the basics you need to be familiar with. For more basic information, see the Medicare publication, Medicare Coverage of Durable Medical Equipment and Other Devices. Feel free to contact 1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week regarding any DME or other Medicare related question you may have.

Sources

Centers for Medicare and Medicaid Services, Medicare Coverage of Durable Medicare Equipment and Other Devices, Medicare.gov

Centers for Medicare and Medicaid Services, DME Medicare Supplier Directory, Medicare.gov

Centers for Medicare and Medicaid Services, Your Medicare Coverage, Medicare.gov

By Evan Davis - I have worked with the 1-800-MEDICARE program for the past 5 years, have been a working shiatsu massage therapist for 9 years, and am a web content producer specializing in Education, health insurance, alter...  





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