Medicare Billing At SpinLife
Need to submit Medicare-related forms to SpinLife? Please fax to: 1-866-716-3278 or email to firstname.lastname@example.org
SpinLife is an authorized Medicare provider and we are happy to assist you in obtaining reimbursement from Medicare for eligible lift chairs, and wheelchair cushions. Items eligible for Medicare reimbursement are marked with this icon: . Please note: SpinLife does not provide courtesy billing for Medicaid, Medicare replacement programs or Medicare supplemental programs.
Please take the time to look through common questions you might have about Medicare billing below. If you need additional help, please call our Medicare specialists at 1-800-850-0335.
How does Medicare "courtesy billing" work?
We understand that the process of submitting claims to Medicare can be difficult and time consuming. To help make the process easier, SpinLife offers what is known as "courtesy billing". This means that after you purchase an eligible product from SpinLife and request at checkout that we courtesy bill Medicare, we send you all of the documentation required by Medicare for you to complete with your physician. Once medically qualifying documentation is submitted into SpinLife, we can submit a claim to Medicare on your behalf. If your claim is approved by Medicare, they will reimburse you directly for their portion of your claim via mail.
Please note the following important information about Medicare courtesy billing:
- In order for us to courtesy bill, Medicare must be your primary insurance. This means you would have a red, white and blue Medicare card.
- We are unable to courtesy bill any Medicare Advantage programs
- We are unable to courtesy bill Medicare if the beneficiary is in a nursing home, skilled nursing facility, home health facility or hospice facility
- We are able to courtesy bill Medicare for beneficiaries in assisted living facilities, and we will need to know that the beneficiary is in an assisted living facility because these claims are filed differently
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How much will I be reimbursed through Medicare?
Medicare assigns every product that is eligible for reimbursement what is called an "allowable amount". The allowable amount is the maximum amount that Medicare will consider as the total price of the item. The allowable amount for each item varies slightly by state. Medicare will reimburse you around 80% of the allowable amount or around 80% of the cost of the item from SpinLife, whichever is less. The other 20%, or copay, remains your responsibility. The product must be paid for in full prior to billing Medicare, and if Medicare determines you are eligible for coverage, they will reimburse you directly.
Because SpinLife’s prices are generally well below the Medicare allowable amount for eligible products, your 20% copay will likely be less than what it would be if you purchased from a local medical equipment supplier. This could mean significant savings on your 20% copay. Here are allowable amounts for items commonly purchased on SpinLife:
- Lift Chair Mechanisms (HCPCS Code E0627): The allowable range is between $250-$300. View a state-by-state reimbursement chart.
- Wheelchair cushions that provide skin protection and/or positioning (HCPCS Code E2605-E2622): The allowable ranges from $250 - $350 for standard sizes, depending on the specific cushion you choose.
Please note the following important information about Medicare reimbursement amounts:
- Any applicable deductibles must be met before Medicare will reimburse you for their portion of the allowable amount on an approved claim.
- While we can't guarantee Medicare reimbursement, we can promise that we’ll work with you to ensure that claims will be filed accurately and completely.
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How does the reimbursement process work?
After purchasing a Medicare-eligible product and requesting that SpinLife bill Medicare on your behalf, we will work with you to complete the required documentation and submit your claim.
Here's the basic process:
Step 1:: We will send you the three documents listed below, which you must read and sign. You may provide your electronic signature online during the checkout process or via the Medicare email that you receive from SpinLife. You may also choose to print, sign and return these documents to SpinLife via fax or mail.
- Medicare Supplier Standards
- HIPAA Privacy Notice
- HIPAA Authorization Form
Step 2: We will ask you to submit the following information to SpinLife for all claims:
- The prescription from your physician for all Medicare eligible equipment. This prescription must have a date that is before the date your product is delivered.
- A copy of your Medicare Card
- Your date of birth
We will ask you to submit the following information to SpinLife depending on the product you purchased:
- For lift chairs only, please have your physician fill out the Certificate of Medical Necessity (CMN) document, which we will provide in your Medicare packet. This document must be signed/dated within 30 days of the written RX date, and can be returned to SpinLife by either the physician's office or by you.
- For cushions only, the manufacturer name, model number, serial number and date of purchase of the wheelchair already on file with Medicare for which the cushion will be required.
Step 3: After all information is received, including the information required by your physician, SpinLife will file your claim with Medicare.
Step 4: Medicare will process your claim. Medicare has between 45-60 days to respond to you regarding your claim and if your claim is approved, you will receive reimbursement directly from Medicare via mail.
Important Note: SpinLife cannot provide courtesy billing for customers that have an HMO Medicare Advantage Plan as their primary coverage (such as Secure Horizons HMO or Humana HMO). An Advantage HMO is a Medicare replacement HMO program whose services have been enlisted to manage your Medicare coverage and benefits.
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What is the reimbursement criteria for lift chairs?
Medicare only covers the seat-lift mechanism, but not the actual chair/furniture portion itself. The reimbursement amount is between $250-$300 depending on the state (view chart) in which the beneficiary is located if the coverage criteria are met. A lift chair is considered medically necessary if all of the following coverage criteria are met:
- The beneficiary must have severe arthritis of the hip or knee only, or have a severe neuromuscular disease. This must be specifically documented by your physician.
- The seat lift mechanism must be a part of the physician's course of treatment and be prescribed to effect improvement, or arrest or retard deterioration in the patient's condition.
- The patient must be completely incapable of standing up from a regular armchair or any chair in their home.
- Once standing, the patient must have the ability to walk, even if a cane, walker or other assistance is required. Medicare will not cover this item if the beneficiary has a wheelchair, scooter, or power wheelchair on file.
- By Medicare standards, the fact that a beneficiary has difficulty or is even incapable of getting up from a chair, particularly a low chair is not sufficient justification for a seat lift mechanism. Almost all beneficiaries who are capable of ambulating can get out of an ordinary chair, if the seat height is appropriate and the chair has arms.
- Medicare requires that the physician ordering the seat lift mechanism must be the attending physician or a consulting physician for the disease or condition resulting in the need for a seat lift.
Beginning January 1, 2014, Medicare will only provide coverage for your lift chair through SpinLife if you do not live within one of the following 9 major metropolitan areas:
- Charlotte-Gastonia-Rock Hill (North Carolina and South Carolina)
- Cincinnati-Middletown (Ohio, Kentucky and Indiana)
- Cleveland-Elyria-Mentor (Ohio)
- Dallas-Fort Worth-Arlington (Texas)
- Kansas City (Missouri and Kansas)
- Miami-Fort Lauderdale-Pompano Beach (Florida)
- Orlando-Kissimmee-Sanford (Florida)
- Pittsburgh (Pennsylvania)
- Riverside-San Bernardino-Ontario (California)
Please click on the link competitive bidding areas to see if your zip code is part of this list. If your zip code is not listed, you are eligible to take part in SpinLife’s non-assigned Medicare billing program.
If you do live within one of these areas and wish to pursue Medicare billing for your lift chair, please visit the Medicare website at www.medicare.com or call 1-800-MEDICARE.
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What is the reimbursement criteria for wheelchair cushions?
For wheelchair cushions, the wheelchair for which the cushion will be used must already be on file with Medicare. When courtesy billing for the corresponding cushion, Medicare requires SpinLife to submit the manufacturer, model, serial number and the date of purchase of the wheelchair on file.
The beneficiary must also either have a current pressure sore or have a previous history of a pressure sore on record due to the fact that Medicare will not cover any preventative items. Documentation of the pressure sore (staging, treatment, etc.) and positioning requirements must also be provided in the form of chart notes from your physician.
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How can I find out if my physician has a valid NPI and PECOS enrollment?
Please note: Effective May 1, 2013, in order to be eligible for Medicare reimbursement on any durable medical equipment purchase, your prescribing physician must:
- Have a valid national provider identifier (NPI).
- Be enrolled in the Medicare Provider Enrollment, Chain and Ownership System (PECOS).
If your prescribing physician does not have a valid NPI or PECOS enrollment, your claim will be denied. To view a list of physicians and non-physician practitioners who have a valid NPI and PECOS enrollment, you can visit this government website and download the PDF document titled Medicare Ordering and Referring File [PDF]. You can also contact your physician's office for this information.
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Additional Information Required by Medicare
Warranty Information (Medicare requires that we provide this information)
Every product sold by our company carries a warranty which can range from 6 months to more than 5 years. SpinLife honors all manufacturer warranties, and will provide replacement parts, free of charge, for Medicare-covered equipment that is under warranty. In addition, an owner’s manual with warranty information will be provided to beneficiaries for all equipment where this manual is available.
Medicare Capped Rental (Medicare requires that we provide this information)
Capped Rental Items are items where Medicare will pay a monthly rental fee for a period not to exceed 13 months, after which the ownership of the equipment is transferred to the Medicare beneficiary and it is the beneficiary’s responsibility to arrange for any required equipment service or repair. Examples of this type of equipment include hospital beds, alternating pressure pads, air-fluidized beds, nebulizers, suction pumps, continuous airway pressure (CPAP) devices, patient lifts and trapeze bars.
Items Inexpensive or Routinely Purchased items Notification (Medicare requires that we provide this information)
Inexpensive or routinely purchased items include Lift Chair seat lift mechanisms, canes, walkers, crutches, commode chairs, low pressure and positioning equalization pads, home blood glucose monitors, pneumatic compressors (lymphedema pumps), bed side rails, and traction equipment. These items can be purchased or rented, although the total amount paid for monthly rentals cannot exceed the fee schedule purchase amount.
SpinLife does not provide rentals and does not provide most of these items with the exception of lift chair seat lift mechanisms. If you would like to rent a lift chair instead of purchasing your lift chair, SpinLife can direct you to a local Medical Equipment dealer who can provide a rental product.
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Can SpinLife bill Medicaid for my items?
Unfortunately, SpinLife cannot provide courtesy billing for Medicaid. We can only courtesy bill Medicare or private insurance.
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