Basic Coverage requirements
1ST REQUIREMENT OF COVERAGE for most insurance companies:
A. Prescription written by Physician or PCP must contain 7 elements
1. Patient name
2. address
3. date of birth
4. Item being ordered
5. length of need
6. physician's signature & dated rx (not date stamped)
7. RX must be hand dated.
RX must be clearly ledgible please
2nd REQUIREMENT OF COVERAGE:
B. Current Clinical notes which clearly justify the medical necessity of the product you are ordering.
current clinical documentation would also include any summaries from hospital discharges as well as
Specialist recommendation, sleep studies, mobility evaluations, neurology & orthopedic consults etc.
*To find the medical necessity requirements you may
1. go on line to Medicare website at: https://www.cms.gov/
2. review our website for summary list of Medicare requirements which we believe are correct.
A. Prescription written by Physician or PCP must contain 7 elements
1. Patient name
2. address
3. date of birth
4. Item being ordered
5. length of need
6. physician's signature & dated rx (not date stamped)
7. RX must be hand dated.
RX must be clearly ledgible please
2nd REQUIREMENT OF COVERAGE:
B. Current Clinical notes which clearly justify the medical necessity of the product you are ordering.
current clinical documentation would also include any summaries from hospital discharges as well as
Specialist recommendation, sleep studies, mobility evaluations, neurology & orthopedic consults etc.
*To find the medical necessity requirements you may
1. go on line to Medicare website at: https://www.cms.gov/
2. review our website for summary list of Medicare requirements which we believe are correct.
We are not guaranteeing information on our website and advise that you may use this information as long as you are aware that our best advise to you is to go directly to Medicare for their current information.
3. The required clinical note documentation is very specific for each of the various covered types of durable medical equipment. Each bullet point on the requirement list must be addressed in your clinical notes as long as the information of course is true.
Insurance regulations in brief:
1. all information you provide us must be legible. If not and we accept it then we may (upon audit) have to
repay all money's. For this reason you will find Rainbow staff will reject your rx and documentation if we
can not read it.
2. Insurance bases reimbursements on an allowable amount. This means that we are paid a "median" price
for the product provided to your patient. Sometimes patient's want a "cadillac" which we can not provide,
rather we will provide a median priced product which will meet the Medicare requirements and allow this
company to make a reasonable profit.
3. We are a participating company with your patient's insurance company. This means that we must follow all
rules and regulations.
4. check sheet forms are not allowed by any insurance company and will be rejected by Rainbow Medical Staff
as we would have to refund $ if we use it as the required documentation.
EXCEPTION: There is only one insurance company that i know of anywhere that requires a check sheet.
this insurance company is HMSA Akamai Advantage which requires a check sheet for hospital bed. When
we have a client with this insurance company coverage we will provide the Physician the proper form.
GOT QUESTIONS?
PLEASE SEE BELOW
PLEASE SEE BELOW
PHONE: 982-3830 or
Email Contact Form
www.rainbowmedicalsupply.com
PHYSICIAN OFFICE & REFERRAL SOURCE ONLY PLEASE:
Ask for our referral source hotline # when you call in first time on patient line.
Email Contact Form
www.rainbowmedicalsupply.com
PHYSICIAN OFFICE & REFERRAL SOURCE ONLY PLEASE:
Ask for our referral source hotline # when you call in first time on patient line.
