Page 48 - May 2021 Issue.indd

than vinegar and call the phone number demographics, but it has certainly
on the bill for help when needed! muddied the waters for all patient’s when
it comes to understanding the billing
Regarding Durable Medical Equipment:
It must be prescribed by a doctor or system. Furthermore, it has created an
licensed health care provider such absolute disaster for the uninsured who
as a Physician’s Assistant or Nurse are self-employed and cannot afford
Practitioner for part “B” to pay. the exorbitant monthly premiums
Equipment can only be supplied by and annual deductibles. Clinics and
ASSISTED LIVING FACILITY a certified Medicare DME supplier. Doctors’ offices efforts to help defray
Medicare will only pay accredited some costs by offering income based
ĂŝůLJ ĐƟǀŝƟĞƐ suppliers for Durable Medical sliding fee scales are great, but not all

RN on Call Equipment, Prosthetics, Orthotics, patients qualify. Think tradesmen with

,ŽŵĞ ŽŽŬĞĚ DĞĂůƐ͕ and Supplies. (DMEPOS)Two local fluctuating incomes. Th ose uninsured,
^ŶĂĐŬƐ Θ ĞǀĞƌĂŐĞƐ CMS certified suppliers who accept who do not qualify for federal and
>ĂƵŶĚƌLJ Θ ,ŽƵƐĞŬĞĞƉŝŶŐ Medicare Assignment and are DEMPOS state programs or sliding fee scales, are
>ŝĐĞŶƐĞĚ ƚŽ WƌŽǀŝĚĞ accredited are Lincare and Hills Drugs, paying service fees that bean counters
ĂƌĞ ĨŽƌ >ĞǀĞůƐ ϭ͕Ϯ͕ϯ but there are more. Should you decide to inflate to offset the big reductions in
compensation offered by Medicare and

DĞŵŽƌLJ ĂƌĞ go another route be sure to confi rm that other Health Care Insurers. Th e higher
^ƉĞĐŝĂů ŝĞƚ Θ ŝŶŝŶŐ ƐƐŝƐƚĂŶĐĞ they are DMEPOS accredited meaning their standard fees are, the less health
WŽƐƚͲƌĞŚĂďŝůŝƚĂƟŽŶ WĂƌƚŶĞƌƐŚŝƉƐ they’ve been vigorously vetted by CMS professionals lose when the economic
ǁŝƚŚ ŽĐƚŽƌƐ ĂŶĚ dŚĞƌĂƉŝƐƚƐ and have met the 42-code set of Federal dust settles. This does not help the
regulations. Verify that they have a CMS
ĂŶĚ ŵƵĐŚ ŵŽƌĞ͘͘͘ uninsured carpenter’s wife who has strep
supplier number, or you could get stuck
www.arcadia-living.com with the full cost of equipment. throat and is charged $175 to walk in
the door so she can pay for a strep test
Arcadia of Denton Examples of DME include reusable and get antibiotics. On the other hand,
701 S. 5th Ave equipment such as in-home hospital Medicare is a slow payer so doctors can
(Formerly Gables at Caroline)
beds, including pressure reducing beds, wait months to be reimbursed for their
Come Home to Arcadia mattress overlays to prevent bed sores, services. Corporate Medicine and Big
continuous passive motion machines, Insurance have everyone dancing to
bed side commodes, non-electric their tune… it’s a real Catch 22, folks!
Medicare, Medicare with a supplemental wheelchairs, walkers, (note that MC

policy, Medicare Advantage, which is will not cover both, it is either/or for Those under 65 who are not on Medicare
QMB beneficiaries only here on the wheelchairs and walkers) manual and are not insured by an employer
shore, employer insurance, or another Hoya or stand assist lifts. Note that should investigate the Maryland
insurer, be sure to read your insurance the mechanical part of a lift chair is Health Connection for information
statements and billing carefully. considered DME, but the entire chair about the Premium Tax Credit. This
Mistakes made with the wrong billing is not. Other examples of DME are is a subsidy/discount program that
code can cause a covered procedure Nebulizer machines and some nebulizer is based on the number of people in
to be denied because it was coded meds, CPAP machines, oxygen your household vs. household income
incorrectly. This can be very costly to the equipment and accessories, infusion and enables enrollment into a private

beneficiary if the error is not found and pumps and supplies for certain drugs, insurance plan. A family of four can
reported early on to the doctor’s offi ce blood sugar monitors, and glucose test make anywhere from $24,300 to $97,000
or facility for correction. Bottom line is strips. Remember that if you rent the to qualify. The discount is applied to
all those who are dependent on Health equipment, the DME supplier is required your monthly insurance premium.
Insurance should read their bills and to maintain or replace faulty equipment Normally, Open Enrollment for this
statements carefully and wait until the for the specified time of the rental. Th ere program is November 1-December 15,

billing process is complete before paying are rental guidelines and limitations set but due to Covid, enrollment has been
for service. Most medical facilities are by Medicare so familiarize yourself with extended until August 15. Call Tina
honest and when billing errors occur those and discuss your needs with your Hyde at 443-477-0085 or go to www.
the billing department employees will do doctor before he writes the order. If marylandhealthconnection.gov for
their best to straighten out a billing issue. you choose to own it, maintenance and information and to enroll.

They understand that no one wants to repairs are on you. Enjoy the gift of Spring and don’t forget

pay more than they are obligated to pay the sunscreen!

and will backtrack records to verify The partnership of Corporate Medicine
the procedure and correct the error. and Big Insurance has expanded
Remember that you get more with sugar health care coverage for many diff erent
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