Medicare Competitive Bid Program Summary

Starting January 1st 2011 Medicare implemented a competitive bid program for certain durable medical equipment items. Everyone within the Orlando metropolitan area will be affected by this change.

Patients needing basic power wheelchairs/scooters, walkers, oxygen, CPAP and respiratory assistive devices, hospital beds, enteral nutrients, and mail order diabetic supplies will have a very limited choice of where to get this equipment and what equipment will be provided. A provider that is able to provide a walker may not be able to provide a hospital bed. Choices of equipment will be very limited if there is any choice at all. Contracted winners are not required to provide a specific make/model unless that is a product line that they carry. So winning contracted providers only carry the lowest end/least costly equipment.

Medicare beneficiaries, family members, caregivers, hospital discharge planners, and clinicians can report problems, concerns, and feedback about this bidding system by calling a toll-free number, 1-888-990-0499, or by visiting the website: www.biddingfeedback.com

The beneficiary will be the person that suffers the most from this program. Due to lack of education of the program, lack of choices, and inability to find a provider that will carry their needed equipment.

Colonial Medical Supplies strongly encourages everyone to look at the program for themselves. Call the toll free number with complaints to help end the competitive bid program.

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Mobility and Medicare

     Medicare has many rules and stipulations when it comes to paying for any type of mobility equipment. This includes a cane, walker, wheelchair, power scooter, power wheelchairs, and transport chairs. Some of the equipment can be purchased and others can only be on a rental basis. Here is some basic information to help you with deciding which mobility equipment would be best according to how Medicare’s guidelines work.

     At first many people may experience an unsteady gait with age. The first step to receiving a device would be to contact your physician. They should determine the cause and will frequently start off ordering a cane. A simple prescription from your physician stating “cane” and your diagnosis is all you need to have us process the claim through Medicare. Medicare only pays for least costly alternative but you may choose an upgrade option if you would like something fancy.

     As time progresses a cane may no longer be suitable and the patient now needs a walker for more support. A walker is also frequently ordered for rehabilitation of a stroke patient. Again just a prescription with a diagnosis is needed. However, always remember if you are seeking a 4 wheeled walker with a seat, the physician must specify this on the prescription.

     When a patient becomes wheelchair bound, Medicare requires we look at long term and short term needs. A healthy patient that is needing a wheelchair short term for a surgery or broken leg would only qualify for a standard wheelchair. Medicare will only provide this on a rental basis. A patient, who is a paraplegic, would qualify for a much more custom fit manual wheelchair as a purchase. The paperwork for the standard chair takes a day or two to get completed from the physician. The provider must have on file chart notes or a face to face evaluation form showing the patient qualifies. For the more custom chair, an evaluation would be required by healthcare professional not affiliated with the provider. There are also forms the provider will supply to physician to complete. Only after all documentation is received would the supplier be able to order the custom equipment.

     Powered operated equipment is much more involved. Many people would like to have independence outside the home even though they are still able to manage in the home with a walker or manual wheelchair. In this case Medicare will not help with the purchase of a scooter or power wheelchair. For any patient to qualify for a powered piece of equipment the first rule is the need for inside the home. If they physician determines the patient must absolutely have this equipment for activities of daily living in the home, the paperwork then begins. A face to face with the physician, prescription, evaluation by a therapist specializing in the equipment, and detailed order provided to the physician by the supplier will all need to be on file before ordering. There are time lines and many specific details regarding the paperwork. This can sometimes take several trips to the physician and a few months to be just right in order for a patient to qualify. It is not just medical necessity any longer; it is also the documentation requirements that matter.

     Lastly Medicare will consider what is commonly known as a transport chair. This is for patients that are no longer able to self propel a manual chair and are no longer cognitively able to use a power wheelchair. This should not go through Medicare as a convenience item to just transport the patient long distances. If for instance someone elderly can walk short distances fine but require something for outside the home, the patient or family should purchase the equipment as it is only considered by Medicare convenience. If a patient does get a transport chair and then later wants a power chair due to a decline in condition, it would be denied by Medicare for same or similar equipment. Also remember, Medicare will not provide any type of cushion on a transport chair. If a patient develops a pressure wound, the cushion normally costs over $400.00. It is highly recommended that when considering a transport chair, all the guidelines for present and future needs are considered.

     Medicare considers replacement equipment every 5 years. At the end of 5 years, if the patient requests new equipment, the equipment must be evaluated to see if it is in need of repair or if it would be less costly to purchase a new one. Again, Medicare wants to choose the least costly alternative. The only exceptions to the 5 year rule are if the patient has had a major change in condition, or the equipment was lost/stolen.

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Lift Chairs…more than just a “Lazyboy”

     Electric lift chairs resemble a “Lazy Boy” type recliner. The main difference is that with the assistance of an electric motor and hand control the chair will lift the user to a standing position eliminating the effort needed to stand from a seated position. This is extremely beneficial for people who suffer from hip or knee pain/arthritis. Also anyone who is affected with any type of neurological disorder.

     Here at Colonial Medical Supplies we carry the top (2) manufacturers of lift chairs, Golden Technologiesand Pride. There are several other less known brands such as Action Lift Chairs, Franklin, Lazy Boy, Kathy Ireland Home and Nexidea to mention a few. There are (3) basic different types of lift chairs all of which do bring the user to a standing position. They are; two position which only elevates the feet and reclines to about a 45 degree angle, three position which reclines back to a “napping” position and infinite position chair which has added a second motor and allows for separate control of the footrest and backrest. With this type of chair the user can achieve a “zero gravity” position which promotes better spinal alignment, better lung capacity and improved circulation. This type of chair will also recline back to a completely flat position. On a side note there is also a product called Uplift, this is a portable unit that is designed to fit most chairs and has either hydraulic lift based on user weight which I personally feel is somewhat “gimmicky” due to the fact you must be able to start to stand before this will assist or an electric version that does work for most people but costs nearly $300.00.

     There are several benefits to shopping for your lift chair at Colonial Medical Supplies. First of all Colonial Medical Supplies currently has (3) retail locations where you can come in to try different lift chairs. At Colonial Medical Supplies corporate office, located in Altamonte Springs, FL, we have a showroom with over 13,000 square feet housing approximately 40 lift chairs in our showroom with several highly trained sales representatives to assist in both educating on any of the products we carry as well as to answer any questions you might have. Colonial Medical Supplies also staffs a fully trained and certified service mechanic to do any/all type of repairs necessary to keep your lift chair functioning properly. This service also includes any type of warranty work as well.

     Colonial Medical Supplieswill also process Medicare billing on your behalf as long as you have a prescription. Medicare only deems the lift mechanism as medically necessary as they do not pay for the chair and do not pre-qualify you for this benefit. The allowable Medicare has established for possible reimbursement is approximately $350.00. That is the maximum amount you may be eligible to get back from Medicare. You do have to pay for the full cost of the lift chair up front as we then will obtain the Medicare documentation, this is a Certificate of Medical Necessity, needed to properly process the claim on your behalf.

     In closing, Colonial Medical Supplies carries the (2) leading manufacturers of lift chairs in the medical manufacturing field, they are Pride and Golden Technologies. We have highly trained staff to assist in all of your durable medical needs as well as to provide insurance billing on your behalf.

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