Will Medicare pay for hospital beds?

When selecting the right insurance plan, it's useful to familiarize yourself with certain terms:

Link to Pukang

In some cases, doctors may determine that a hospital bed is medically necessary for a patient's care at home. If deemed necessary, Medicare will help with the costs associated with acquiring this durable medical equipment (DME).

Under Medicare, once a doctor prescribes the use of a hospital bed for home use, Medicare typically covers 80% of the expenses through Part B. Depending on the plan, Medigap and Medicare Advantage may potentially cover additional costs.

Most patients choose to rent DME, yet purchasing options are frequently available. Individuals should evaluate whether renting or buying a hospital bed is the better choice for their circumstances.

To qualify as DME, items must meet specific requirements:

Medicare covers particular types of durable medical equipment (DME), including hospital beds, when supported by a physician's prescription.

Medicare Coverage for Hospital Beds

Original Medicare will cover hospital beds intended for home use, provided certain criteria are satisfied. It is essential for both the prescribing doctor and the supplier of the hospital bed to be enrolled in Medicare. Patients are advised to confirm the supplier's participation in Medicare prior to obtaining any form of DME from them.

For Medicare Part B to cover the costs associated with a hospital bed, the prescribing physician must submit a prescription along with comprehensive documentation. This includes detailed information about the patient's medical condition to demonstrate the necessity of the hospital bed. The documentation should cover:

• Evidence that indicates the patient requires the bed's positioning to:
  • Alleviate pain
  • Ensure body alignment
  • Prevent respiratory infections
• Justification for the need for special attachments not compatible with a conventional bed.

Supplemental insurance like Medigap can assist in covering hospital bed expenses as well. Medicare Advantage (Part C) plans must provide the same benefits as Original Medicare, which generally includes coverage for home hospital beds. Consulting with a provider can yield additional insights.

To learn more about Medicare Part B, please follow the links provided.

Regulations Surrounding Hospital Beds

Coverage and Payment Rules

For an item to be eligible for Medicare coverage, it must meet the following criteria: 1) fall into a defined Medicare benefit category, 2) be reasonable and necessary for diagnosing or treating an illness or injury, or improve bodily function, and 3) adhere to all relevant Medicare statutory and regulatory requirements.

Hospital beds qualify under the Durable Medical Equipment benefit (Social Security Act §(s)(6)). To obtain reimbursement for the equipment, the necessary criteria outlined in the applicable Local Coverage Determination must be fulfilled. Additional specific policies regarding payment must also be adhered to.

When billing for a hospital bed, a face-to-face consultation and a Written Order Prior to Delivery (WOPD) are required according to the Final Rule (84 Fed. Reg Vol 217). Failure to meet these requirements may result in denial of claims. It's important for suppliers to secure a WOPD before delivering any equipment, as subsequent retrieval will not change the denial status.

Documentation Requirements

Beyond the specific documentation stipulated for certain items, general documentation requirements apply across all DMEPOS policies. For comprehensive information surrounding these general and policy-specific documentation requirements, please refer to the relevant resources in the LCD.

Modifiers

Suppliers should add a KX modifier to a hospital bed code only if all criteria for medical necessity are fully met. If requirements are not satisfied, then GA or GZ modifiers must be utilized for claims concerning hospital beds and accessories.

Upgrades also necessitate specific modifiers such as GA, GK, GL, and/or GZ. All fully electric hospital beds should be billed using these modifiers.

Conclusion

Understanding how Medicare approaches the coverage of hospital beds can significantly impact the healthcare decisions patients make. If you're seeking further details or looking into equipment options, you can visit electric hospital beds for sale for an array of products tailored to various needs.

In addition, for information about other items like hospital trolleys, please explore our resources.