Re: FW: Question about Medicare and DME

[Guest guest]

There is an algorithm for determine what is the most appropriate piece

of Mobility Assistive Equipment (MAE). Number 5 of the algorithm

addresses whether a walker is safe. If the walk is not safe for use,

then by the algorithm, it is not considered reasonable and necessary

and thus non-billable. Now, in all honesty, the algorithm is developed

to help determine all types of MAE, not just walkers. I don't know how

applicable it is in this situation, but I would surely think that it

would bear heavily.

The MAE Algorithm can be found in Medlearn Matters MM3791

--

Ron Carson MHS, OTR/L

HOPE Therapy Services

===============<Original Message>===============

On 6/15/2006, howellpt@... said:

TH> Hi everyone,

TH> I have a Medicare home health patient who is having problems with a DME

TH> supplier and I am trying to find out more information on her behalf. She is

TH> making phone calls as well. She has need of bariatric equipment including

TH> a front wheeled walker. She has been using a loaner walker from the SNF she

TH> was in but it has to be returned. The DME company delivered a new walker but

TH> it is still not quite large enough and posed a small risk of loss of

TH> balance. (This company did have her weight at the time they ordered the

TH> equipment.) They told her after delivery that it would take 2 weeks to get

TH> another appropriate sized walker AND they would not leave any type of

TH> loaner. They told her she had to return the walker they delivered the next

TH> day (on Saturday) or they would bill Medicare.

TH> This patient cannot get around without the walker so she decided to keep the

TH> walker that was delivered for now since her loaner must go back. She felt

TH> she had no choice. She did not let me know about all this until today so I

TH> need to back track and see what can be done.

TH> Does the DME company have the right to bill Medicare for this equipment,

TH> even thought it is the wrong size for her?

TH> Do they have to provide a loaner if it takes so long to get equipment in?

TH> Is the two weeks reasonable for waiting for bariatric equipment? This is

TH> the Boise, Idaho metro area but that seemed ridiculous!

TH> Needless to say, this patient will not use this company if possible but she

TH> is moving back to her home (staying with family now) in a smaller town soon

TH> and there may not be a choice. Besides being poor customer service, it

TH> seems that this company may be violating Medicare policy. While we are

TH> tracking down information, I would appreciate any input on what we may or

TH> may not be able to do.

TH> Thanks!

TH> Tom Howell, P.T., M.P.T.

TH> Howell Physical Therapy

TH> Eagle, ID

TH> howellpt@...

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