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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: 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: Please note the following important information about Medicare reimbursement amounts:
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. 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. Step 2: We will ask you to submit the following information to SpinLife for all claims: We will ask you to submit the following information to SpinLife depending on the product you purchased: 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. 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: Beginning January 1, 2014, Medicare will only provide coverage for your lift chair through SpinLife if you DO NOT live within one of these major metropolitan areas. 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. 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. 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:
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. 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.