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The Future of Medicare and Lift Chair Reimbursement



As the baby boomer generation continues to age, it may become more difficult to obtain Medicare reimbursement for items such as lift chairs.In the last thirty years, Medicare has seen an exponential increase in billing for durable medical equipment (DME), including the lift recliners Medicare partially covers for its enrollees. If patients carry Part B of the Medicare benefit, they are able to have some equipment reimbursed. However, the DME industry has taken advantage of this benefit, and there has been a large spike in the number of providers. Certainly, the Baby Boomers are aging and in need of more assistance, but there's also plenty of proof, from the Office of the Inspector General, that many of these businesses are not legitimate. This adds up to Medicare fraud as well as the provision of unsafe equipment and supplies to those who needs them.


Revisions in Medicare's DME Reimbursement


In order to reduce the amount of Medicare fraud, as well as insure the safety and integrity of the DME benefit, the Health Care Reform act significantly increased its authority over DME providers. The new law requires that all medical equipment providers be licensed and registered with Medicare in order to bill for reimbursement. For the patient, it will be important to be informed about who is complying with the new rules. If a patient rents or buys from a non-approved company, the Medicare claim will be rejected, and the patient will be responsible for the bill.


This is the most significant change to Medicare's rules, where the patient is concerned. However, there are also fail safes in place that will help monitor the safety and legitimacy of DME providers. Per the new rules, Medicare can do database checks to guarantee that all billing information is correct with each provider. The surveyors can also do unannounced site checks to insure that all equipment meets government standards.


Medicare Reimbursement and Lift Chairs


There have definitely been changes to the reimbursement rules for lift chairs Medicare will pay for. Thirty years ago, the entire chair could be billed to Medicare Part B. In the 1980s, lift chairs were mostly regular recliners that were retrofitted with spring lift mechanisms. Most were unreliable and unsafe.


Medicare began to change its position on reimbursement to not only reduce financial waste, but to also protect the safety of people who used lift chairs. The first rules required that the lift mechanism be an electric motor that moved smoothly. Eventually, Medicare changed its reimbursement to only include the lift mechanism itself. Today, that payment is no more than $300.


Requirements to Get Medicare Reimbursement For a Lift Chair


In order to be eligible for reimbursement for lift recliners Medicare requires a prescription from a doctor that states the DME is medically necessary. Patients and DME providers will not be able to bill for the chair without the prescription. Medicare has the authority to not only check the provider's records, but the patient's records through the prescribing doctor.


As the healthcare crisis in America continues to grow, and the legislature continues to grapple with making the Medicare benefit last, patients, doctors, and DME providers can expect to see more strict oversight, and less reimbursement for medical equipment.