Medicare/Medicaid
Patient received a walker in 2024 through their Medicare insurance. However, their doctor is now ordering them a rollator but did not provide notes. What is needed to help?
Medicare will only cover same or similar items once every 5 years. If the patient still wants item they can either pay OOP with and ABN stating they know why they are paying OOP or they can still try to bill through Medicare but again would still have to sign an ABN saying they know if denied they are responsible for the cost.
What is the qualifying SAT for Oxygen?
Patient must have a walk test showing their Room air SAT whether it is during exertion or not is 88% or lower.
What is each employee required to have on them at all times?
Name Badge.
PAP patient calls in with questions about their supplies and how to maintain it. How do we assist?
If in store, we can provide them a copy of the cleaning and replacement guidelines. We can also email it to them.
True OR False
Anything going through insurance requires a prescription.
TRUE
We cannot bill for anything we do not have an RX for.
True OR False
Medicare will disguise as patients and call into the store seeking help.
TRUE
They call is Medicare secret shopper calls. This is why we answer and close the call with a script.
How long is the rental for all Oxygen no matter the insurance?
When starting Oxygen services with us, a patient has about a year to switch providers. If they do not, then they are in a 5 yr contract with us. First 3 yrs are billing to insurance and the last 2 yrs are maintenance.
Do we provide a backup system for Oxygen patients?
Yes.
Patient's 2lpm or less get 2 E Tanks
3lpm or higher get a M Tank
Treu OR False
Patient does not have to be sleeping to meet the hour compliance that is required.
TRUE
Most patients who are new to PAP have a hard time with the machine. It is always suggested to practice using the machine during the day as it all counts towards compliance.
Retail pricing sheet.
Patient comes in with their Medicare card and the card shows Part A only. What does that mean?
Part A only means their Medicare only covers hospital stays and nothing DME.
Patient calls in to get some cannulas and tubing but is worried about the cost. How to do we get them the price of these items.
If they are actively renting Oxygen from us, the cost of the supplies is billed into their rental fees for the Oxygen.
Welcome Guide
What is the usage requirement and window time frame for the patient to meet the compliance for PAP?
Patient must use the machine for a minimum of 4hrs a day within a 30-day time frame but a patient has 90 days to meet that requirement.
Why does the insurance rent the equipment?
Most of the equipment goes as a rental so it gives the patient/family the choice of returning the equipment if it is no longer needed.
With PAP, they follow the same reason but more so they want to make sure patients are compliant if they are going to help pay for it.
True OR False
Medicaid is a month to month coverage.
TRUE
Very important to make sure we check each time upon entering account in BT the insurance.
True OR False
Patient's SAT levels go to 89% and can still qualify for Oxygen.
TRUE
If a patient goes to 89% they can qualify for short term(group 2) Oxygen which means they have to requalify in 3 months with PCP for Oxygen.
Wendy R.
Medicare patient comes in stating their PAP device is not working. What do we do to help?
ALL Medicare patients who are ACTIVELY RENTING PAP machine, we are contracted to switch out the machine for a new one.
If not actively renting, follow same procedure as normal.
How do you a patient who has UHC is a Synapse patient?
You have to check their group number against the "Synapse-UHC code," sheet provided.
If you do not have it, I will provide.
What is the rental period time frame for Medicare?
13 months
DME is rent to own through the insurance and will rent for 13 months. At the end of the rental period and once the 13th payment is collected the DME is PT owned.
A patient calls in stating that they are traveling out of state and need a TOC. What do we need to do to help them?
We need to first check and make sure they are actively renting Oxygen from us. Then make sure we have a TOC for them to reserve at NO COST.
If they are not renting Oxygen from us, we need an RX for them to rent OOP.
What is the first thing you should verify when assisting a patient on the phone and in person?
Verify their address and see if their insurance has changed.
Patient visiting from out of state is needing a new mask. How can we assist them?
We can check to see if they are already in the BT system and have a current RX.
If they do not have a current RX, we can advise that they get a copy to us so we can service them.
Patient calls in wanting to check on their Afflo Vest. How do we help them?
The Afflo vest is processed by our Trach/Vent team. We would need to look through the notes to see if there is anything but also get the patients best contact info and get it over to that team.