possible medicare reimburse men booklet

7/31/2019 Possible Medicare Reimburse Men Booklet

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How to Apply for PossibleMEDICARE REIMBURSEMENT

For Your New

RANE HYBRID TUB

Copyright 2010-2011 Walk In Bathtubs LLC


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Possible Medicare Reimbursement

Regular Walk In Tubs and Hybrid Tubs occupy a gray area when it comes to the question of

whether or not Medicare will reimburse a portion of their cost.

On the one hand, neither regular walk in tubs nor Hybrid Tubs are on the official list of Durable

Medical Equipment (DME) on which Medicare normally approves claims. Therefore, as a

general practice, Medicare does not reimburse any part of a walk in or Hybrid tub purchase.

On the other hand, when claims are made, occasionally Medicare does reimburse a part of the

tubs purchase price. This might be because they see these safe access tubs as so beneficial to

the lives of the people they serveat least in some situations. If Medicare does approve your

claim, you can then file a claim with your Medicare Supplement Insurance for additional

reimbursement.

Various groups are working to resolve this gray area situation by trying to get these tubs

officially listed by Medicare as Durable Medical Equipment. Many people feel that these tubs

belong on the DME list alongside other already-approved mobility assisting, home safety,

quality-of-life enhancing DME items such as:

Canes

Commode Chairs

Crutches

Hospital Beds

Patient Lifts

Scooters

Walkers

Wheelchairs

Many safe access tub users also have DMEs like wheelchairs, scooters or walkers. In fact, three

Rane Hybrid Tub models are designed for easy accommodation of Patient Lifts.

It is also worth noting that Rane Institutional tubs are approved for use in VA and Department

of Defense Hospitals worldwide. The RH4, RH6 and RB14 models available for your home are

very similar to the models used in hospitals and other care facilities.

All Rane Hybrid Tubs are specifically designed to be the Safest Access Residential

Tubsespecially important to those with mobility issues or the debilitating fear of falling.


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There appear to be two reasons regular walk in tubs and Hybrid Tubs are not already officially

recognized DMEs.

1. They can be viewed as Conveniences rather than Medical Necessities

2. They could be used by others, not only by the person with the special needs

Those tub buyers who have been successful getting Medicare reimbursement probably have

overcome these two problems with a convincing claim presentation about their unique

situation, mobility issues and medical necessity that is, needed for the treatment of their

medical conditions.

The only way to find out if you can get reimbursement for your tub purchase is to go through

the Medicare claim process and see what happens.

Your Medicare claim can only be filed after you first satisfy several requirements and then buy

the tub. Because much of the claim filing process is after you buy your tub, you must be sureyou can afford the tub on your own and have no expectation of getting any Medicare

reimbursement.

Any tub buyer can file a claim as long as they are enrolled in Medicare Part B (Medical

Insurance). Because these tubs are not officially DMEs, the claim must be filed by you rather

than by the supplier. The process is not difficult, but like most government programs, you must

follow the correct procedure.

The following suggested process will help you create a strong presentation for your Medicare

Claim. It might increase your chances of partial Medicare reimbursement for your Rane HybridTub. However, even with a good presentation, you would be well served to have an attitude of

total joy with your new Hybrid Tub and no expectations of Medicare reimbursement. Then, if

you do get your claim approvedCelebrate the unexpected.

Medicare Claim Process

1. Decide to buy a Rane Hybrid Tub because

Safest Access Residential Tubs

Best Cost/Value available anywhere

Brim full of Benefits to give you a lifetime of blissful bathing

Eliminates the cause of most bathtub falls

2. Get a Prescription from your Doctor


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A Prescription is mandatory for your Medicare Claim

3. Ask for a Letter of Recommendation from your Doctor (Optional, but very helpful)

This is your Doctors letter of support

It supports the medical necessity of the tub It might describe your medical condition, how it benefits your living situation,

benefits of the tub, how it treats your conditions, or whatever your Doctor

chooses to write

4. Buy the Rane Hybrid Tub of your choice

Order, receive and install your tub

Retain all paperwork

Make a copy of the Invoice and your proof of paymenttub only, as Medicare will

not reimburse construction costs, etc.

5. Enjoy the many Benefits of your new Rane Hybrid Tub

Note especially how good it makes you feelphysically, mentally, spiritually

Note changes and improvements in your medical condition, quality of life, etc.

Note specifics like pain relief, safe access, reduced fear of falling, etc.

6. Compose a Personal Letter

This is basically an appreciation letter for the new tub in your life

Express your thoughts and feelings now that you have experienced your new tub Include what you noted abovethings like your improved medical condition, not

having to be bathed by someone else, relieved from the debilitating fear of

falling, improved stay-at-home independence and quality of life, etc.

Sign your letter

7. Complete Medicare Form CMS-1490S

You must be enrolled in Medicare Part B (Medical Insurance) to file any claim

Download Form CMS-1490S and Instructions (

If other questions, visit the Medicare website at www.medicare.gov

8. Download Your Rane Hybrid Tub Summary

This is a summary of your tub model to give the Medicare Claims Examiner

pictures, descriptions, benefits and details about the tub you purchased

RM3 RHZ,Z


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Print a copy for inclusion in your Claim

9. Claim Filing Statement

Because regular walk in tubs and Hybrid Tubs are not yet officially designated

DMEs, the company cannot file the claim for youyou must file it yourself

That being the case, Medicare will return your claim unless you include the

following statement

The supplier did not refuse to file a claim for a Medicare-covered item or

refused to enroll in Medicare. Because this claim is for a Hybrid Tub, not

currently listed as Durable Medical Equipment and therefore the supplier

cannot file the claim, I am filing the claim

a copy of the Claim Filing Statement to your^

10. Compile your original Claim, consisting of:

Form CMS-1490S completed per Instructions (#7)

Doctors Prescriptionoriginal attached to back of Form CMS-1490S (#2)

Doctors Letter of Recommendationif Doctor provided (#3)

Your Personal Letter (#6)

Rane Hybrid Tub Model Summary (#8)

Tub Invoice and Proof of Payment

Claim Filing Statement (#9)

Anything else you feel might help support your claim

11. Copy your Claim

Make a copy of everything (#10)

Retain in your files

12. Mail your original Claim

Staple your Claim together so nothing gets lost

Enclose everything in a 9 X 12 envelope, keeping everything flat

Put your Return Address on the envelope Address envelope to the correct Medicare address for your state

Address Table

Attach sufficient postage and mail

Now sit back and enjoy your tub!


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Medicare will respond to your Claim (keep everything they send you) as either

1. Denied

Know that you made a good try for reimbursement

Enjoy a lifetime of bathing bliss in your new Rane Hybrid Tub

2. Approved

CONGRATULATIONS !

Now you can file a Claim with your Medigap (Medicare Supplement Insurance)

Contact your Supplement Insurance Agent immediately to find out their next

steps

They will need copies of what Medicare sent you and may handle the Claim filing

for you

Enjoy a lifetime of bathing bliss in your new Rane Hybrid Tub

Please help us help others

It would be helpful if you shared your Medicare response with useither Denied or Approved.

We will keep your identity private, but could use the information to improve the suggested

process for others to benefit.

Also, your responses could further assist in getting these tubs officially approved by Medicare

as Durable Medical Equipmentmuch to the benefit of many more people.

Please email your Medicare response information to:

[email protected]

Thank you.


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Use the following address table to ensure the correct address will beprovided on the claim.

If you live in: Return your form to:

Connecticut, Delaware, District ofColumbia, Maine, Maryland,Massachusetts, New Hampshire, NewJersey, New York, Pennsylvania,Rhode Island, Vermont

NHIC, Corp.P.O. Box 9165Hingham, MA 02043-9165

Illinois, Indiana, Kentucky, Michigan,Minnesota, Ohio, Wisconsin

National Government Services, Inc.DMEPOS OperationsMedicare DMEPOS ClaimsP.O. Box 7027Indianapolis, IN 46207-7027

Alabama, Arkansas, Colorado, Florida,Georgia, Louisiana, Mississippi, NewMexico, North Carolina, Oklahoma,Puerto Rico, South Carolina,Tennessee, Texas, U.S. Virgin Islands,Virginia, West Virginia

CIGNA Government ServicesP.O. Box 20010Nashville, TN 37202-0010

Alaska, American Samoa, Arizona,California, Guam, Hawaii, Idaho, Iowa,Kansas, Missouri, Montana, Nebraska,Nevada, North Dakota, NorthernMariana Islands, Oregon, SouthDakota, Utah, Washington, Wyoming

Noridian Administrative ServicesP.O. Box 6727Fargo, ND 58108-6727


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IMPORTANT SEE OTHER SIDE FOR INSTRUCTIONS

PLEASE TYPE OR PRINT INFORMATION MEDICAL INSURANCE BENEFITS SOCIAL SECURITY AC

PATIENTS REQUEST FOR MEDICAL PAYMEN

Signature of Patient (If patient is unable to sign, see Block 6 on reverse) Date signed

NOTICE: Anyone who misrepresents or falsifies essential information requested by this form may upon conviction be subject to fine and imprisonment unde

Federal law. No Part B Medicare benefits may be paid unless this form is received as required by existing law and regulations (20 CFR 422.510).

FORM APPRO

OMB NO 0938

Name of Beneficiary from Health Insurance Card SEND COMPLETED FORM TO:

(Last) (First) (Middle)

1

2

3

4

5

6

3b

4b

4c

Patients SexClaim Number from Health Insurance Card

Male

Female

Patients Mailing Address (City, State, Zip Code)

Check here if this is a new address

(Street or P.O. Box Include Apartment Number)

(City) (State) (Zip)

Describe the illness or injury for which patient received treatment

Telephone Number(Include Area Code)

a. Are you employed and covered under an employee health plan? Yes No

b. Is your spouse employed and are you covered under your spouses employee

health plan? Yes No

c. If you have any medical coverage other than Medicare, such as private insurance, employment related insurance,

State Agency (Medicaid), or the VA, complete:

Name and Address of other insurance, State Agency (Medicaid), or VA office

Policyholders Name:

Note: If you DO NOT want payment information on this claim released, put an (X) here

Condition was related to:

A. Patients employment

Yes No

B. Accident

Auto Other

Policy or Medical Assistance No

I AUTHORIZE ANY HOLDER OF MEDICAL OR OTHER INFORMATION ABOUT ME TO RELEASE TO THE SOCIAL SECURITY ADMINISTRATIONAND CENTERS FOR MEDICARE & MEDICAID SERVICES OR ITS INTERMEDIARIES OR CARRIERS ANY INFORMATION NEEDED FOR THIS ORELATED MEDICARE CLAIM. I PERMIT A COPY OF THIS AUTHORIZATION TO BE USED IN PLACE OF THE ORIGINAL, AND REQUEST PAYMOF MEDICAL INSURANCE BENEFITS TO ME.

6b

IMPORTANTATTACH ITEMIZED BILLS FROM YOUR DOCTOR(S) OR SUPPLIER(S) TO THE BACK OF THIS FORM

Was patient being treated withchronic dialysis or kidney transplan

Yes No

( )

_

DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR MEDICARE & MEDICAID SERVICES

Your Medicare Carrier

If you need help, call 1-800-MEDICARE

(1-800-633-4227)

Form CMS-1490S (SC) (01/05) EF 02/2005


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HOW TO FILL OUT THIS MEDICARE FORM

Medicare will pay you directly when you complete this form and attach an itemized bill from your doctor or supplier. Your bill does not have to be paid before you subhis claim for payment, but you MUST attach an itemized bill in order for Medicare to process this claim. Mail your completed claim form to the Medicare Carrier responsor processing your claim. If you do not know the address of your carrier, call 1-800-MEDICARE (1-800-633-4227).

FOLLOW THESE INSTRUCTIONS CAREFULLY:

A. Completion of this form.

Block 1. Print your name shown on your Medicare Card (Last Name, First Name, Middle Name).

Block 2. Print your Health Insurance Claim Number including the letter at the end exactly as it is shown on your Medicare card.Check the appropriate box for the patients sex.

Block 3. Furnish your mailing address and include your telephone number in Block 3b.

Block 4. Describe the illness or injury for which you received treatment. Check the appropriate box in Blocks 4b and 4c.

Block 5a. Complete this Block if you are age 65 or older and enrolled in a health insurance plan where you are currently working.

Block 5b. Complete this Block if you are age 65 or older and enrolled in a health insurance plan where your spouse is currently working.

Block 5c. Complete this Block if you have any medical coverage other than Medicare. Be sure to provide the Policy or Medical Assistance Number. You may checkbox provided if you do not wish payment information from this claim released to your other insurer.

Block 6. Be sure to sign your name. If you cannot write your name, make an (X) mark. Then have a witness sign his or her name and address in Block 6 too.

If you are completing this form for another Medicare patient you should write (By) and sign your name and address in Block 6. You also shouldshow your relationship to the patient and briefly explain why the patient cannot sign.

Block 6b. Print the date you completed this form.

B. Each itemized bill MUST show all of the following information:

Date of each service

Place of each serviceDoctors Office Independent Laboratory Outpatient HospitalNursing Home Patients Home Inpatient Hospital

Description of each surgical or medical service or supply furnished.

Charge for EACH service.

Doctors or suppliers name and address. Many times a bill will show the names of several doctors or suppliers. IT IS VERY IMPORTANT THE ONE WHO TREAYOU BE IDENTIFIED. Simply circle his/her name on the bill.

It is helpful if the diagnosis is also shown on the physicians bill. If not, be sure you have completed Block 4 of this form.

Mark out any services on the bill(s) you are attaching for which you have already filed a Medicare claim.

If the patient is deceased, please contact your Social Security office for instructions on how to file a claim.

Attach an Explanation of Medicare Benefits notice from the other insurer if you are also requesting Medicare payment.

COLLECTION AND USE OF MEDICARE INFORMATION

We are authorized by the Centers for Medicare & Medicaid Services to ask you for information needed in the administration of the Medic

program. Authority to collect information is in section 205(a), 1872 and 1875 of the Social Security Act, as amended.

The information we obtain to complete your Medicare claim is used to identify you and to determine your eligibility. It is also used to dec

f the services and supplies you received are covered by Medicare and to insure that proper payment is made.

The information may also be given to other providers of services, carriers, intermediaries, medical review boards, and other organizationsnecessary to administer the Medicare program. For example, it may be necessary to disclose information to a hospital or doctor about the

Medicare benefits you have used.

With one exception, which is discussed below, there are no penalties under Social Security law for refusing to supply information. Howev

failure to furnish information regarding the medical services rendered or the amount charged would prevent payment of the claim. Failure

furnish any other information, such as name or claim number, would delay payment of the claim.

t is mandatory that you tell us if you are being treated for a work related injury so we can determine whether workers compensation will pa

for the treatment. Section 1877(a)(3) of the Social Security Act provides criminal penalties for withholding this information.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control numhis information collection is 0938-0008. The time required to complete this information collection is estimated to average 16 minutes per response, including the time to review instructions, searchinng data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improviorm, please write to: CMS, Attn: PRA Reports Clearance Officer, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.

DO NOT MAIL COMPLETED CLAIM FORMS TO THIS ADDRESS.


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Medicare Claim Filing Statement

The supplier did not refuse to file a claim for a Medicare-covered item or refused to enroll in

Medicare. Because this claim is for a Hybrid Tub, not currently listed as Durable Medical

Equipment and therefore the supplier cannot file the claim, I am filing the claim.

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