What Information Do You Need from Your Doctor for a Medicare Order?

  • Jan - 01 - 2021
  • Elixair Medical

Doctor talking to elderly man about prescriptionAt Elixair Medical, we carry a wide variety of personal medical equipment that is essential for the care of numerous conditions—from mobility aids to oxygen therapy and more, our products are key to improving quality of life for many patients. Because of how essential these products are to their overall health and well-being, many of our patients are able to have the cost of this equipment covered (in full or in part) by Medicare. However, it’s important that you get the right documents from your doctor to ensure that the expense will be covered. Keep reading to learn more about what you need before we can dispense a Medicare order.

Types of Equipment Covered

First, it’s important to understand what types of equipment you can actually have covered by Medicare Part B. It would do you little good to request documentation from your doctor, only to discover your medical insurance through Medicare doesn’t actually provide for that type of equipment.

Medicare can cover a wide variety of durable medical equipment (DME) that is deemed medically necessary for use in your home. The most common types of DME covered are:

  • Blood sugar monitors and test strips
  • Mobility aids (canes, walkers, wheelchairs, scooters, etc.)
  • CPAP devices
  • Hospital beds
  • Oxygen therapy equipment and accessories
  • Pressure-reducing support surfaces (i.e., our decubitus care equipment)
  • Nebulizers and accompanying medications

This is, of course, not a comprehensive list, and if the equipment you need isn’t listed, reach out to your insurance provider to determine if the equipment will be covered. Generally speaking, however, Medicare will cover at least part of DME prescribed by your doctor, so long as it meets the following criteria:

  • Intended for repeated use (durable)
  • Used for a medical reason
  • Isn’t a useful piece of equipment unless sick or injured
  • Is used in the home
  • Is expected to last at least 3 years
  • Is essential to your care and quality of life

Speak to your doctor or Medicare representative if you have further questions about having your equipment covered, or reach out to us with any questions about how we handle Medicare claims.

Documentation from Your Doctor

Now that you have a better understanding of what kinds of equipment Medicare can cover, let’s discuss the documentation that you need from your doctor in order for us to submit a Medicare order.

It is absolutely essential that you have an official prescription from your doctor for the equipment you’re purchasing. It must come from the physician providing treatment for your condition, and must include all of the following:

  • Your diagnosis
  • Approximately how long you’ll need the equipment
  • Your doctor’s name and signature
  • The date of prescription

This should all be on an official prescription pad.

Additionally, you’ll need progress notes from your medical records. Those notes must include a clear statement of your need for the equipment. As an example, let’s say you’re purchasing an adjustable hospital bed for your home. Your progress notes should include one of the following statements:

  • If you have a diagnosis of respiratory need: “Head must be elevated more than 30 degrees due to respiratory condition. Wedge was considered inadequate.”
  • If your need is related to pain: “Patient requires body positioning not possible with regular bed in order to alleviate pain. Wedge was considered inadequate.”

It’s important to note that, if there is another possible solution that is smaller and/or less expensive for treating your condition, your progress notes should eliminate that option, as shown above. Other examples might include eliminating a cane or walker as a possibility if you’re ordering a wheelchair or scooter, and so on.

If your progress notes are written by a nurse, these will only be accepted if the ordering physician has signed them as well.

Ensuring Your Provider Is Enrolled

Finally, it is absolutely essential that you ensure both your doctor and your supplier for your DME are enrolled in Medicare. Medicare will only provide coverage if they are both enrolled in the program. Make sure that you double check this with your doctor if you want to avoid a nasty surprise when Medicare rejects your claim.

Elixair Medical is included in Medicare’s directory of approved suppliers. We have worked to ensure we meet all of their strict requirements to be a part of their program so that our customers can receive the quality equipment they need to live comfortably at home, no matter what their medical condition. To learn more about the DME we provide, contact us today.