Insurance Reimbursement

MEDICARE & PRIVATE INSURANCE FILING

Hieline Mobility Solutions does not bill Medicare or private insurance companies and therefore does not accept Medicare or insurance as payment. If you haven’t yet, contact your insurance company directly to find out eligibility requirements.

To take advantage of Medicare or insurance coverage, you generally have 2 choices:

1.   The fastest way to get the equipment is to buy it yourself and then submit a claim to Medicare or your insurance company for reimbursement. The product will be delivered to your door in 2-3 days.

If you choose to take this route, please have the following documents ready to submit your claim:

• Our invoice
• Doctor’s prescription and diagnosis codes
• Certificate of Medical Necessity (CMN)
• Proof of delivery
• For Medicare claims, submit Form CMS-1490S

Medicare will reimburse 80% and your supplementary insurance will cover the rest.

2. If you want to use your insurance as payment, you need to find a local DME company that accepts Medicare assignment. To find the closet provider to you call 1-800-MEDICARE or visit https://www.medicare.gov/supplierdirectory/search.html

You should know that getting medical equipment through Medicare is a lengthy process. Normally, it takes 4-6 months before getting the equipment you need.

Electric Mobility Scooters

If you are having difficulty with mobility or feel that you aren’t able to get around safely, there are mobility products available to help you. A mobility aid will allow you to maintain your independence and improve your safety from falls and injuries.
These aids range from canes and walkers for people who are fairly mobile, to electric scooters, manual wheelchairs, and power wheelchairs for those with significantly decreased mobility. If you fall into the last category, an evaluation is necessary to determine if a scooter, manual wheelchair, or electric wheelchair is best for your needs.

Get an Evaluation

The first step in getting a mobility aid is to be evaluated by your doctor. An occupational therapist may conduct your evaluation, but the doctor must first write a prescription if you are using your Medicare coverage. The doctor or therapist uses certain criteria to decide which mobility product is best for you.
The following will be checked during your evaluation:

• Your overall strength: If your upper body and legs are weak, you may not have the strength to use an electric scooter or manual wheelchair. To use a scooter, you have to be able to hold yourself upright without assistance or support.
• Your upper-body strength: Even if you have sufficient body strength, you must have enough strength in your upper body, arms, and hands in order to operate a mobility scooter. Your upper-body strength will also determine if you are able to operate a manual wheelchair or if you need an electric wheelchair.
• Your balance: If your balance is impaired and your posture is poor, you may not be able to remain upright to use a manual wheelchair or stay on a scooter.

Choosing an Electric Scooter

If your evaluation has established that an electric scooter is the mobility product that best fits your requirements, you can begin to decide what type of scooter you need. There are many styles of scooters with a wide variety of options and accessories.

All models of scooters have the same basic features. They have a seat on top of a wheeled platform and a column at the front with controls or hand-rests. The column is called the tiller. The base unit will offer support for your feet and contains the drive system and battery.

Your doctor or therapist will have specific results that will help determine your choice. For instance, if you have less hand strength, that will mean that you would have difficulty using hand controls. Other types of controls are available. The following are other factors to consider:

• Where will you use your scooter? Electric scooters are available in three- or four-wheeled models. If you will be using your scooter primarily outdoors, the four-wheeled model will offer more stability and is easier on rough terrain. The three-wheeled model works well inside since it is easier to maneuver in smaller spaces.
• Will you be taking your scooter with you in your vehicle? There are full-size electric scooters and portable scooters. The portable scooter can be folded and placed in a vehicle. This is good if you are still driving and don’t want to purchase an additional scooter lift that is necessary for a full-size scooter.

Medicare coverage for electric mobility scooters

Medicare Part B will cover most of the cost of electric mobility scooters, but only if your doctor determines that it is medically necessary. The scooter must also be used primarily for moving about your home and not as a “recreational” vehicle. You may have to pay up to 20 percent of the cost after meeting your Part B deductible.

Other requirements for Medicare coverage include:

• Your evaluation must be with a doctor or other qualified health provider
• The evaluation must be documented and say that you need a mobility aid for a medical condition (called a “Certificate of Medical Necessity)
• You must present the order or prescription to the Medicare-approved electric scooter supplier before Medicare can be billed
• You must be able to safely operate, and get on and get off of the scooter
• You must have good vision
• You must have a health condition that causes difficulty for you to move around in your home

Recent changes to Medicare coverage for mobility scooters

There have been several recent changes to Medicare coverage for “Durable Medical Equipment,” which includes medical supplies and electric mobility scooters. It’s important that you read and understand these changes.

1. Competitive bidding

In an effort to cut costs, Medicare began to implement what is called “competitive bidding” at the beginning of 2011. The program requires providers and suppliers of Durable Medical Equipment to submit competitive bids for their products in order to stay or become Medicare-approved. Under this new rule, you must use Medicare-approved suppliers, or Medicare will not pay for the item.

This rule is currently effective in several metropolitan areas in the following states: CA, FL, IN, KS, KY, MO, NC, OH, PA, SC, and TX. If you live in one these areas—or get Durable Medical Equipment while visiting one of these areas—you will have to use a supplier that participates in the competitive bidding program. Beginning in 2012, the program is scheduled to expand to an additional 91 metropolitan areas, and by 2016, it will be effective in regions in all 50 states.

If you have questions about covered suppliers, go to www.medicare.gov/supplier to search for Medicare-approved suppliers or call 1-800-MEDICARE (1-800-633-4227).

2. New rental requirements

In the past, Medicare beneficiaries had the option to either purchase or rent their mobility scooters. However, as of January 1, 2011, Medicare beneficiaries can only rent the equipment over a 13-month period. Once the 13-month rental period is complete, the equipment supplier will transfer ownership to the beneficiary.

Under these new guidelines, you will be billed thirteen times instead of once to satisfy your Medicare coinsurance for the mobility scooter. For example, if your coinsurance amount is $200, you will pay about $15 a month for 13 months rather than paying the entire amount upfront in one lump payment.

It’s important to know that these new rental requirements do not apply to standard mobility scooters or power wheelchairs furnished in the competitive bidding areas listed above. They also do not apply to complex, rehabilitative wheelchairs, such as those with power seating systems or special controls.

3. Stricter evaluation guidelines

There are also now much stricter guidelines for doctors and providers who evaluate your need for a mobility aid. These evaluations have always been face-to-face for Medicare to approve a wheelchair or scooter, but now these evaluations are even more lengthy and detailed.

Finally, if you have a Medicare Advantage Plan, you should check with your individual plan to be sure you follow their guidelines to get your electric mobility scooter.
In an effort to cut costs, Medicare began to implement what is called “Competitive Bidding” at the end of 2010. This meant that Medicare-approved providers and suppliers of durable medical equipment were required to submit competitive bids for their products. There is a selection process in which the “winning” bids and those suppliers become Medicare-approved.

Also, there are now much stricter guidelines for doctors and providers who evaluate your need for a mobility aid. These evaluations have always been face-to-face for Medicare to approve a wheelchair or scooter, but now these evaluations are even more lengthy and detailed.

NOTE: It’s important to be sure that any supplier of durable medical equipment that you select is still or has become a Medicare-approved provider.

If you have questions about covered suppliers, go to www.medicare.gov/supplier where Medicare-approved suppliers are listed or call 1-800-MEDICARE (1-800-633-4227).

If you have a Medicare Advantage Plan, be sure to check with your individual plan to be sure you follow their guidelines to get your electric mobility scooter.