Durable Medical Equipment

Important Terminology
Written by Nancy McMahon   
Durable medical equipment has to be reusable to be considered as “durable” and includes such items as wheelchairs, oxygen equipment and crutches.  This equipment also includes hospital beds, patient lifts, power scooters and nebulizers. The durable medical equipment must be considered to be necessary due to a patient’s physical and medical condition and it must be needed in the home of the patient.

Blood-glucose monitors and the strips used in them are also considered to be durable medical equipment. It also includes things like , where the lift mechanism is covered, but the chair often is not covered.

The durable medical equipment could be needed for only a short few weeks or months, or it may be equipment that will be needed for the rest of an individual’s life. Often the length of time the equipment will be needed will determine whether it has to be rented or purchased.

It is really important to check with your insurance carrier or with Medicare on the specific requirements of your policy. Some equipment must be purchased or rented from policy approved vendors.

Terminology

Because it is so important to understand your insurance or Medicare policy when it comes to durable medical equipment, here are some words and phrases you need to know. The terms may have several meanings, but the one used here is as it relates to durable medical equipment.

These terms may vary with each policy, and are intended for education purposes only. Make sure you check with your carrier to understand your requirements when it comes to renting or buying durable medical equipment.

General Terms

  • Assignment: Is an agreement between a person with insurance or Medicare and a doctor or supplier, and the insurance carrier or Medicare. Doctors or suppliers who accept assignment from the insurance company or Medicare agree to accept the approved payment amount as full payment.
  • Capped Rental Item: This term is often used for durable medical equipment that costs more than $150 and might include items like oxygen, nebulizers, and manual wheelchairs.
  • Coinsurance: These are amounts an individual has to pay for services after paying any plan deductibles.
  • Deductible: Is the amount a patient must pay for any health care before the insurance or Original Medicare begins to pay. The deductible must be paid each year and the deductible amount can change.
  • Patient Lifts: Are devices and equipment utilized to lift a patient in and out of bed, a wheel chair, or other chair.

Medicare Terms

  • Certificate of Medical Necessity: This is a specific form required by Medicare. This form must be filled out by your doctor or medical provider to get Medicare coverage for specific types of durable medical equipment.
  • Coinsurance: As with general insurance, with Medicare these are amounts you may be required to pay for services, after you’ve covered any plan deductibles. In Original Medicare, this percentage is taken on the Medicare approved amount. An individual is required to pay this amount after the Part A and/or Part B deductible has been paid.
  • Medically Necessary: This means that the durable medical equipment is needed to either diagnosis or treat of a patient’s medical condition.
  • Medicare Advantage Plan (Part C): is a Medicare plan that is offered by a private company under contract with Medicare. This plan provides an individual with all the Medicare Part A and Part B benefits. Sometimes called Part C, Medicare Advantage Plans can be provided by either HMOs, Private Fee-for-Service Plans, PPOs, or Medicare Medical Savings Account Plans. If you have a Medicare Advantage Plan, then your services are covered by this plan and not under the original Medicare plan.
  • Original Medicare: The original Medicare plan offers two parts. Part A covers hospital insurance and Part B covers medical insurance. This plan is a fee-for-service health plan. Once you pay your specified deductible, Medicare covers its share of the Medicare-approved amount, and you pay the specified coinsurance amount and deductible.
  • Medicare-Approved Amount: Original Medicare has an approved amount that the doctor or supplier can be paid if they accept Medicare assignment. This amount includes what Medicare pays, the deductible and any copayment or coinsurance. The Medicare-Approved amount is often less than what the doctor or supplier charges for the equipment.

Summary

Durable Medical Equipment is reusable medical equipment that must be ordered by a doctor, a nurse practitioner, physician’s assistant, or clinical nurse specialist to be used by individuals in their home. This equipment must be required to improve the quality of life or be a medical necessity for home use.

 It cannot be equipment that is used out of the home only, but can be used both in and out of the home. Hospitals and nursing homes don’t qualify as a home, but a long-term facility does. The durable medical equipment items are things like walkers, crutches, blood-glucose monitors and hospital beds.
 
Next >
You are here  :Home Basics Important Terminology