Home Care Medical

Our Mission – To enhance the quality of life of those we serve

Insurance Updates + Guidelines

Medicare and Medicaid Guidelines

Medicare

Medicare Part B covers Durable Medical Equipment (DME) that is medically necessary. Enrollment in Medicare Part B is voluntary, unlike Part A benefits. Medicare may cover 80% of the allowed amount, and the beneficiary is responsible for the remaining 20%. In some cases the beneficiary may have secondary insurance coverage that will pay the balance due.

As a Durable Medical Equipment provider, Home Care Medical has the responsibility of obtaining documentation necessary to support coverage criteria for the equipment/supplies ordered. To determine if the beneficiary meets Medicare’s coverage criteria, you may be asked to provide additional supporting documentation, such as chart notes, therapy notes, or test results etc., when placing the order. When the documentation does not support the item(s) prescribed, Home Care Medical may ask your patient to sign an Advanced Beneficiary Notice of Noncoverage (ABN).

The ABN is a written notice given to a Medicare beneficiary before providing services, which are expected to be denied by Medicare. The purpose of the ABN is to allow your patient to make a decision before receiving services that will probably be denied by Medicare. This process allows the Medicare beneficiary to make an informed consumer decision if they choose to receive services that may or may not have to pay “out of pocket.” Home Care Medical will pursue payment from the secondary insurance, when applicable.

A noncovered item is defined as an item or supply that has no reimbursement. For more information, click on Noncovered items.


Medicaid

Medicaid is a State and Federal partnership, which provides coverage for low income, elderly, disabled, and families with children. Medicaid will cover Durable Medical Equipment (DME) that is medically necessary. Medicaid has multiple coverage plans, therefore copay amounts may vary.

As a Durable Medical Equipment provider, Home Care Medical has the responsibility of obtaining documentation necessary to support coverage criteria for the equipment/supplies ordered. To determine if the beneficiary meets Medicaid’s coverage criteria, you may be asked to provide additional supporting documentation, such as chart notes, therapy notes, or test results etc., when placing the order. Medicaid does not accept stamped or electronic signatures, and a physical signature will be requested on prescription/order.

A Prior Authorization (PA) may be required for the equipment/supplies ordered prior to delivery. Home Care Medical will submit the PA request with the supporting documentation you provide, along with the signed prescription.

A noncovered item is defined as an item or supply that has no reimbursement. For more information, click on Noncovered items.


Our Billing Department

Billing Department Our Billing department is available Monday through Friday from 8:30 a.m. to
4:30 p.m. to answer your questions on: your insurance deductibles and co-payments. In addition, we can explain what Home Care Medical products and services are covered under your insurance; however, the benefit information provided by our Billing Department is a brief summary of your benefits and not a guarantee of coverage. For more information on your policy, please contact your individual insurance carrier for a more comprehensive description of coverage and benefits.

Home Care Medical Billing Department
5665 South Westridge Drive
New Berlin, Wisconsin 53151
Ph 262.957.5206
Fax 262.957.5279
Billing@HCMedical.com


Managed Care Relationships

Our Managed Care Relationships provides a complete list of Insurance Companies – Commercial, Medicaid and Medicare; Networks; and Hospice Agencies, Nursing Services and Facilities that Home Care Medical is pleased to work with.