The process begins with the physician's order.  Medicare bases patient's needs on the treating physician's medical necessity.

Medicare has Part A, Part B, and Part C.  Part A is coverage for hospitalization.  Part B is for home medical equipment.  Part B gives the beneficiary the choice of provider.  Part C is when beneficiaries turn their traditional Medicare benefits in for HMO coverage.  Generally Part C beneficiaries will have to look in their book from their HMO and find a provider who is on their list.  HMO's contract with companies who provide oxygen, home care, nursing care, and DME.

DR. RX------> ASSESSMENT-------> REPORTS-------> DOCTOR CMN------> APPROVAL------> ORDER EQUIPMENT-------> DELIVERY & FITTING-------> SUBMIT FOR PAYMENT------> FOLLOW UP.

There are certain items that only require a physician's RX, but many items including wheelchairs, scooters, lift chairs, beds, and support surfaces require CMN's.  Items that are custom of nature require a therapist report to medically justify the equipment.  

PHYSICIAN'S ORDERS

Suppliers must have an order from the treating physician before dispensing an item to a beneficiary; except for items requiring a written order prior to delivery, the dispensing order may be a written, faxed, or verbal order.  The dispensing order must include:

                                     * PATIENT'S NAME                                              

                                     * DATE OF BIRTH

                                     * DIAGNOSIS

                                     * EQUIPMENT NAME / DESCRIPTION

                                     * REASON / NEED FOR EQUIPMENT

                                     * LENGTH OF NEED OF EQUIPMENT