Medicare Capped Rental Services Notification

Transcript

1 Medicare Capped Rental and Inexpensive or Routinely Purchased Items Notification for Services on or afte r January 1, 2006 I received instructions and understand that Medicare defines the ____________________ that I received as being either a capped rent al or an inexpensive or routinely purchased item. ____ FOR CAPPED RENTAL ITEMS: Medicare will pay a monthly rental fee fo r a period not to exceed 13 months, after • ansferred to the Medicare beneficiary. which ownership of the equipment is tr After ownership of the equipm dicare beneficiary, it is • ent is transferred to the Me lity to arrange for any re quired equipment service or the beneficiary’s responsibi repair. • Examples of this type of equipment include: Hospital beds, wheelchairs, alternating pressure pads, air-fluidized beds, nebulizers, suction pumps, continuous ai rway pressure (CPAP) devices, patient lifts, and trapeze bars. INELY PURCHASED ITEMS: ____ FOR INEXPENSIVE OR ROUT • Equipment in this category can be purchased or rented; however, the total amount ceed the fee schedule purchase amount. paid for monthly rentals cannot ex Examples of this type of equipment include: • Canes, walkers, crutches, commode chairs, low pressure and positioning equalization pads, home blood glucose monito rs, seat lift mechanisms, pneumatic compressors (lymphedema pumps), bed side rails, and traction equipment. • I select the: Purchase Option __________ Rental Option __________ __________________________________________ ________________________ Beneficiary Signature Date

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