Durable Medical Equipment

Durable Medical Equipment and Oxygen
Written by Nancy McMahon   
In order for equipment to be considered durable medical equipment, it must be reusable.

Reusable medical equipment would include things like wheelchairs, crutches, blood-glucose monitors and the strips used in them. It also includes things like chair-lifts, where the lift mechanism is covered, but the chair is often not covered.

This type of equipment may also include hospital beds, patient lifts, power scooters and nebulizers. In order to be paid by Medicare or other insurance programs the durable medical equipment must be considered to be necessary due to a patient’s physical and medical condition and it must be needed for use in the home of the patient.

The durable medical equipment might be required for a short time, or it may be equipment that will be needed for the rest of an individual’s life. Often the determining factor for whether the equipment will be approved for rental or purchase is based on how long a patient will need it.

This is true for many things, but there are changes as of January, 1, 2009 with how Medicare deals with patients who need Oxygen in the home. Oxygen and the equipment to use it, is considered durable medical equipment. But this equipment is treated in a different manner than any other type of equipment.

It is really important to check with your insurance carrier or with Medicare on the specific requirements of your policy. There is some general information provided below.

How Does Medicare Pay Suppliers for Oxygen Equipment

At the beginning of 2009, changes in Medicare regulations have altered the way suppliers for oxygen equipment and supplies are paid. The new rules specify that instead of the patient owning the equipment after leasing it for 36 months, the suppliers will still own the equipment.

The oxygen supplier will be required to provide the oxygen equipment and related supplies for two year after your three year rental period is over for a total of five years, or as long as the oxygen is prescribed as medically necessary.

Monthly rental payments made to the oxygen equipment supplier will not only cover the oxygen equipment, but also any supplies and accessories. This would include things like tubing, a mouthpiece, maintenance, servicing and repairs, and the actual oxygen gas. Medicare will pay 80% of this rental amount. The patient must pay any unpaid Part B deductible and the remaining 20% of the monthly rental.

After 36 Months

Once the supplier has been paid for 36 months, the supplier still needs to furnish your oxygen and oxygen equipment for up to 5 years. By Medicare regulations, the supplier is required to maintain in good working order, the oxygen equipment. They must also provide any necessary supplies and accessories during this extended two year period.

After the 36 month payment period, the supplier can’t charge you for the remaining two years on the contract. The oxygen tanks or cylinders with the gaseous or liquid oxygen will be paid for by Medicare after the 36-month rental period.

After The Five Year Period

Once the original 36 month payment period and the two year extension has ended, the supplier is no longer obligated to continue furnishing your oxygen or oxygen equipment. At this time you can renew for an additional 36-month period with the same supplier, or you can get your equipment and oxygen from any approved Medicare supplier. This means that a new 36-month payment period and 5-year supplier obligation period will begin.

Supplier Problems

During your five year contracted period, if the supplier does not provide the equipment, supplies and maintenance as Medicare rules and laws require, you can contact Medicare. This is true both during the 36 month period where you are paying a monthly rental and once the original 36 months is up and the supplier is required to continue the service for two more years.

Call 1-800-MEDICARE or 1-800-633-4227, and speak with a customer service representative. Your case will be referred to the correct area. users need to call 1-877-486-2048.

Summary

Durable Medical Equipment like oxygen equipment and supplies are classified as reusable medical equipment. This medical equipment 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 and be a medical necessity for use in the home.

The durable medical equipment must be required for home use, it cannot be equipment that is used out of the home only, but it can be used for both inside and outside use. Hospitals and nursing homes don’t qualify as a home, but a long-term facility does. The durable medical equipment items also include walkers, crutches, blood-glucose monitors and hospital beds, and more.
 
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