Every day we get calls and inquiries from residents and clinicians in central Pennsylvania with question on how to acquire a power wheelchair with Medicare funding. There are strict guidelines that must be followed if you are in need of a power wheelchair and your primary insurance is Medicare. Here is an overview of the process.
In 2005 with the passage of the National Coverage Determination (NCD) process, the Centers for Medicare and Medicaid Services (CMS) devised a plan to determine how prescriptions for power wheelchairs would be approved for Medicare beneficiaries in order to ensure that patients whose condition and quality of life would be improved by a power wheelchair are able to get access to one using Medicare funds.
The basic requirements for a patient receiving a prescription for a power wheelchair through Medicare funding is that they are able to demonstrate that their mobility is so limited that they cannot move around their own home sufficiently using another mobility aid device such as a walker, cane, or manually-operated wheelchair. Another important basic requirement of obtaining a power wheelchair through Medicare funding is that the patient must also be able to prove that they can operate the power wheelchair efficiently and safely without posing any sort of risk to themselves or others.
There are also many questions that a Medicare beneficiary and their caregiver must answer before the beneficiary is approved for a power wheelchair prescription that will be covered by Medicare funding. Even if a patient is unable to use any sort of walking mobility aid device or a manually-operated wheelchair, they still might not be able to get approved for a power wheelchair via Medicare funding if their caregiver is willing, able, and present to help them move around in a manually-operated wheelchair. The safety of the environment the patient will be using the power wheelchair in as well as the extent of their condition must also be assessed before approval is given for access to a power wheelchair via Medicare funding.
Before obtaining a power wheelchair via Medicare funding, the patient must go in for an in-person evaluation conducted by their regular doctor or another medical professional. This is one of the last steps a patient must take before they are eligible to get a power wheelchair funded through Medicare. During the in-person appointment, the doctor must conduct a final evaluation of the patient in order to make his or her professional recommendation regarding whether the patient should be given access to a power wheelchair via Medicare funding. If the doctor decides that a power wheelchair is necessary for their patient, they must fill out, sign, and date a prescription for the power wheelchair, which must be taken to the desired wheelchair supplier no more than forty-five days after the in-person appointment was conducted in order for the prescription to remain valid.
Once a patient receives a final evaluation and signed prescription from their regular physician, they are free to obtain their power wheelchair using Medicare funding, with whatever limitations, restrictions, or lack thereof were placed upon the prescription by their doctor.
Keystone Mobility has been providing power mobility products for residents in Dauphin, Lancaster, York, Harrisburg, Cumberland and other surrounding areas in central Pennsylvania for many years and we are very qualified to work with your healthcare team to make sure these guidelines are met and the appropriate paperwork is submitted for funding. Our mobility specialist are highly trained to not only make sure these processes are met but also the most appropriate mobility, seating and positioning products are selected to meet the unique needs of the consumers. Contact us today with your Medicare questions or to set up a comprehensive wheelchair evaluation.