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Medicare News and Updates

  • Medicare Reimbursement and Me: A Guide to Filing for Reimbursement

    How do I know when to file a claim?

    When a provider, such as a medical supply company, does not accept a Medicare assignment you will need to begin the process to file a claim for reimbursement.

    How do I know what will be reimbursed?

    All claim reimbursement is governed by the set standard Medicare reimbursement rates, even if your bill from the provider was more than the approved Medicare amount. Non-participating medical suppliers are not subject to charge limiting but your reimbursement amount will remain the same.

    How do I file a claim?

    Once you’re ready to file your claim to Medicare you will need a few things to make sure that your claim can be processed quickly and you receive the amount of your set standard Medicare reimbursement rate.

    You will need a copy of the Medicare CMS-1490S form (also known as the Patient Request for Medicare Payment form), an itemized bill from your medical supply company, a letter explaining why you are submitting the claim (Medicare not accepted by provider, etc.), and any supporting documentation (such as a prescription, or doctor/physical therapist recommendation form). HME Medical Shop can provide this letter after your purchase. Just call or reply back to your confirmation email!

    Do I need to fill out an Authorization to Disclose Personal Health Information?

    This form is only necessary if:

    • Someone is contacting Medicare on your behalf
    • If you are authorizing Medicare to give your personal medical information to someone other than yourself

    How long do I have to file for Medicare Reimbursement?

    You have 12 months from your service date to file for reimbursement on all purchases covered by Medicare claims.

    Once you have all of your information together you will need to submit your claim to the proper Medicare office. They are listed below for your convenience but are also located with the CMS-1490S form.

     

    If you live in:Return your form to:
    Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, VermontNoridian Healthcare Solutions P.O. Box 6780 Fargo, ND 58108-6780
    Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, WisconsinCGS Administrators, LLC P.O. Box 20013 Nashville, TN 37202
    Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, U.S. Virgin Islands, Virginia, West VirginiaCGS Administrators, LLC P.O. Box 20010 Nashville, TN 37202-0010
    Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Northern Mariana Islands, Oregon, South Dakota, Utah, Washington, WyomingNoridian Healthcare Solutions P.O. Box 6727 Fargo, ND 58108-6727
  • Should I Use Medicare When Purchasing HME Products?

    How to Navigate Medicare

    Navigating Medicare

    Navigating the ins and outs of insurance to obtain medical products can seem daunting. At HME Medical, we do not want you to feel confused or intimidated by these proceedings. Look over this infographic and let’s get rolling!

    Medicare of HME?

    When deciding how to procure the medical products you need, you have choices. If you opt for Medicare, you will receive your item (eventually), but service is slow and you must choose from one or two providers. If you purchase directly from HME Medical, you will get your quality products quickly and for a reasonable price without having to deal with the hassle of the medicare system and filing piles of paperwork.

    Competitive Bidding

    In most areas of the US, Medicare’s Competitive Bidding Program comes into play. This means that Medicare is not guaranteed to pay for products unless they are provided by a specific supplier. If you live in an area affected by Competitive Bidding, and use Medicare, you may purchase through their suppliers. OR you can skip the paperwork and the wait and get your equipment directly from HME Medical Shop.

    • Not yet affected by Competitive Bidding. Receive no advantages from Medicare. Virtually all parts of the country will be affected by Competitive Bidding by the end of 2016. (In Map)
    • Areas affected by Round 1 (In Map)
    • Areas affected by Round 2 (In Map)

    What About Original Medicare?

    If you have original Medicare and are not in an area affected by Competitive Bidding, then you pay the supplier 20% of the approved amount if they accept your assignment. (the reimbursement for Part B also applies)

    Despite the fact that you can sometimes get your medical products cheaper, this complex process is time consuming. Obtaining your supplies directly from a company like HME will get your products to you faster and with less hassle.

  • Medicare Covered Preventive Screening Services

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    Medicare covered services can include: Exams, Shots/Immunizations, Lab tests and some types of Screenings. In fact, over 20 of these preventive services are included. They also include health monitoring, counseling and education programs. These Services and Screenings are approved by Medicare in order to help prevent more serious medical conditions among seniors. In addition to the screenings and services - Flu, Hepatitis, and Pneumonia vaccinations are also covered. Virtually all of the screenings, shots, and vaccinations can be completed by your primary care physician or any other provider accredited for these services. Many pharmacies are also able to provide the shots and vaccines listed below. Medicare produced a video explaining the program.

    Watch the Video Below to learn More:

    Specific Preventative Programs and Screenings Covered by Medicare

    Click Below to Learn More About These

     

    Vaccines Covered by Medicare

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