SEAT LIFT CHAIRS
Lift Chair Instructions for Reimbursement (pdf)
Certificate of Medical Necessity Medicare Form (pdf)
Advance Beneficiary Notice (pdf)
Medical Prescription
HOSPITAL BEDS FORMS
Medical Prescription
Advance Beneficiary Notice (pdf)
Patient CHART/MEDICAL NOTES from doctor
POWER CHAIRS AND
SCOOTERS
Advance Beneficiary Notice (pdf)
PERSCRIPTION
Power Chair/ Scooter: What your Doctor needs to know (pdf)
Power Chair/Scooter: Face to Face Meeting (pdf)
Power Chair/Scooter: Letter to Doctor (pdf)
FACE TO FACE REPORT
PATIENT CHART/MEDICAL NOTES
DETAILED PRODUCT DESCRIPTION
1. Call Electro-PEDIC at 800-727-1954.
Ask for Jay Rajendra, Medicare Specialist. He will ask
your Name, Date of Birth, Medicare Number, Name and contact information of
your Doctor. He will discuss your Mobility Issues within your Home
Environment. If Jay feels you qualify for Medicare, he will then have
our Medicare Biller, Delores Keller, call Medicare to see if you qualify
for a Medicare Powerchair or Medicare Scooter.
2. You are required to have a FACE-TO-FACE
Examination with your Doctor concerning the Medical Necessity of your Power
Wheel Chair or Mobility Scooter. Our Medicare Biller, Delores
Keller, will notify your Doctor what the Doctor is required to do.
Your Medical Records supporting your Medicare Claim will then be faxed to
us: 818-332-1158
3. After your FACE-TO-FACE Examination, your
Doctor's will fax his Prescription for a Powerchair or Mobility Scooter to
us: fax 818-332-1158.
We can then deliver you the Powerchair or Mobility Scooter. Upon delivery,
we will also take an in-home evaluation to make sure you can adequately and
safely operate your Power Operated Vehicle.
If you need or desire some upgrades that Medicare does not pay for, you are
required to sign an ABM form that lists items that may not covered by Medicare
and the charges you are directly responsible for (example, a scooter cover
is not paid for by medicare). example form:
Advance Beneficiary Notice
(pdf)
26 Supplier Standards (pdf)
HIPAA PRIVACY Manual (pdf)
PATIENT BILL of RIGHTS and RESPONSIBILITIES (pdf)
Falls, Fire and Home Safety (pdf)
Patient Satisfaction Survey (pdf)
For Medical Paperwork and Medicare Questions,
please call 800-727-1954
Ask for:
Jay Rajendra, Medicare Specialist
Hours: Monday thru Thursday 10 - 6, Sat 10-4
"let Jay make it very easy for you!"
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