How to get a Hospital Bed Covered by Medicare

Due to a multitude of conditions, getting in and out of bed and sleeping through the night can be a difficult, sometimes dangerous situation. Having a hospital bed can make the difference between living independently in one’s Minnesota home and moving into a senior living community. Doctors may even require that their patient obtain  a hospital bed for home use before they can leave a hospital or care facility. As with many medical supplies, getting a hospital bed covered by Medicare is a detailed, sometimes arduous process. Having knowledge of the requirements well in advance of needing a hospital bed and working with an experienced supplier of durable medical equipment (DME) will increase your chances of getting coverage in a timely manner.

hospital bed mnFirst, if you live in a Medicare Competitive Bidding Area (CBA) such as Minneapolis, you will have to find a medical equipment company that won the bid to supply hospital beds to Medicare beneficiaries, such as Liberty Oxygen and Medical Equipment.  If you don’t know which providers you can use, you can go to www.Medicare.gov.  On the bottom left side of the landing page, click on the tab “find supplier of medical equipment and supplies.” The next page will ask you to put in your zip code, and hit go.  This will bring up a list of contracted providers in your area.

Second, you need to have a face to face evaluation with a physician’s assistant, nurse practitioner, clinical nurse specialist, or physician within six months prior to having a written prescription.  During this encounter, the physician or practitioner must document in the patient’s medical record:

1)      a needs assessment for the patient;

2)      the benefit to the patient in having a hospital bed; or how the bed would treat the patient for their medical condition that supports the need for the hospital bed; and

3)      the patient’s diagnosis and/or medical condition.

The evaluation documented in the medical record must be signed by the physician, regardless of who actually performed the face to face evaluation.

Next, even if a hospital bed is prescribed by a physician, in order for Medicare to pay for it, the patient has to meet the Medicare guidelines for a semi-electric hospital bed. Medicare does not pay for full-electric hospital beds under any circumstance.  The requirements are that the patient’s medical condition requires body positioning not possible in an ordinary bed due to any of the following:

1)      Alleviating pain

2)      Needing their head to be elevated more than 30 degrees due to CHF/chronic pulmonary disease and /or aspiration

3)      Requiring traction equipment that can only be attached to a hospital bed

4)      The patient requires frequent and/or immediate changes in body position.

Liberty Oxygen and Medical Equipment has a hospital bed coverage criteria form that outlines these requirements that can be completed and used as appropriate documentation. Contact any one of our 8 locations in Minnesota.

Finally, Medicare requires the medical equipment provider to collect all the appropriate documentation, as well as a written prescription, in order to get coverage for the hospital bed.  The written prescription must contain the following five pieces of information:

1)      The date of the order

2)      The beneficiary’s name

3)      The medical equipment being ordered

4)      The prescribing practitioner’s NPI number

5)      Dated signature of the prescribing practitioner

The documentation that is required is a copy of the medical records that contains the face to face encounter signed by the physician that shows  the coverage criteria has been met, along with the patient’s demographics.

Getting a hospital bed covered by Medicare requires attention to detail, persistence and a knowledgeable network of service providers. Having a hospital bed in your Minneapolis home can provide safety and independence.

Posted on: August 15th, 2014 by Francis Sheehy in Medical Equipment | 3 Comments

3 Responses

  1. Chris Rivard says:

    Great advice! We’ll keep this information for our home care clients who need a hospital bed. Glad to know you’re close to us in St. Louis Park!
    http://www.adulthelpcare.com

  2. MY MOTHER IN NEED OF A HOSPITAL BED BEFORE GOING HOME FROM THE HOSPITAL, SHE HAS DIFFICULTY GETTING OUTOFBED AND WALKING, ANY HELP WOULD BE APPRECIATED

  3. Patsy Reinhart says:

    We live in a Medicare Competitive Bidding Area, my husband needs a bariatric hospital bed and he is 6’4″ and needs a longer bed than standard.
    Does medicare cover this type of needed items, he also needs a trapeze bar of some sort.

    Thank you

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