Hospital Bed Semi-Electric

Do you have a detailed written order No, there is no detailed order available. M E delivery? To dispense the hospital bed an ABN must be signed. The ABN needs to state that no written order is available at the D Yes, I have a detailed written order. time of dispensing. The ABN price needs to be the total I cost of the hospital bed. C A Does the patient’s medical documentation state one R or more of the following criteria? E 1. The patient has a condition which requires positioning of the body in ways not feasible with an ordinary bed. Elevation of the head/upper body less than 30 degrees does not usually require the use of a hospital bed! No, the patient does not have one or more of the described Is it documented that the patient’s conditions. 2. The patient requires positioning of the body limitations in their daily activities will be To dispense the hospital bed an ABN stating the specific in ways not feasible with an ordinary bed in condition that does not constitute the need for a hospital improvedorder by to the alleviate use ofpain. a wheelchair? bed.

3. The patient requires the head of the bed to be elevated more than 30 degrees most of the time due to congestive heart failure, chronic pulmonary disease, or problems with aspiration. (Pillows and wedges must have been considered and ruled out!)

Yes,4. thereThe is patient documentation requires that tractionthe patient equipment or the caregiver that will be canable onlyto safely be operate attached the wheelchairto a hospital in the bed.home.

Yes, the patient does meet one or more of the above conditions.

Does your patient require frequent changes No, the patient does not require frequent changes in body in body position, and/or has an immediate position, and/or has an immediate need for a change in body position. need for change in body position? To dispense the hospital bed an ABN stating that the patient’s does not require frequent body changes in position, and/or does not have an immediate need for a Yes the patient requires frequent body position, and/or has change in body position. an immediate need for a change in body position.

The patient qualifies for a Hospital Bed

Rev 10/4/2012 Hospital Bed Heavy Duty Extra Wide

Do you have a detailed written order No, there is no detailed order available. M delivery? To dispense the hospital bed an ABN must be signed. The E ABN needs to state that no written order is available at the D Yes, I have a detailed written order. time of dispensing. The ABN price needs to be the total I cost of the hospital bed. C A Does the patient’s medical documentation state one R or more of the following criteria? E 5. The patient has a condition which requires positioning of the body in ways not feasible with an ordinary bed. Elevation of the head/upper body less than 30 degrees does not usually require the use of a hospital bed! No, the patient does not have one or more of the described Is it documented that the patient’s conditions. 6. The patient requires positioning of the body limitations in their daily activities will be To dispense the hospital bed an ABN stating the specific in ways not feasible with an ordinary bed in condition that does not constitute the need for a hospital improvedorder by to the alleviate use ofpain. a wheelchair? bed.

7. The patient requires the head of the bed to be elevated more than 30 degrees most of the time due to congestive heart failure, chronic pulmonary disease, or problems with aspiration. (Pillows and wedges must have been considered and ruled out!)

Yes,8. thereThe is patient documentation requires that tractionthe patient equipment or the caregiver that will be canable onlyto safely be operate attached the wheelchairto a hospital in the bed.home.

Yes, the patient does meet one or more of the above conditions.

No, the patient does not require frequent changes in body Does your patient require frequent changes position, and/or has an immediate need for a change in in body position, and/or has an immediate body position.

need for change in body position? To dispense the hospital bed an ABN stating that the patient’s does not require frequent body changes in position, and/or does not have an immediate need for a change in body position. Yes the patient requires frequent body position, and/or has an immediate need for a change in body position.

Does your patient weigh ≥ 350 lbs but not No, the patient does not meet this weight criteria.

exceed 600lbs? To dispense the hospital bed an ABN stating that the patient does not meet the weight criteria and why must be completed and signed. Yes, the patient’s weight is ≥ 350 but not over 600lbs.

The patient qualifies for a Hospital Bed.

Rev 10/4/2012

Hospital Bed Extra Heavy Duty Hospital bed

Do you have a detailed written order No, there is no detailed order available. M E delivery? To dispense the hospital bed an ABN must be signed. The ABN needs to state that no written order is available at the D Yes, I have a detailed written order. time of dispensing. The ABN price needs to be the total I cost of the hospital bed. C A Does the patient’s medical documentation state one R or more of the following criteria? E 9. The patient has a condition which requires positioning of the body in ways not feasible with an ordinary bed. Elevation of the head/upper body less than 30 degrees does not usually require the use of a hospital bed! No, the patient does not have one or more of the described Is it documented that the patient’s conditions. 10. The patient requires positioning of the body limitations in their daily activities will be To dispense the hospital bed an ABN stating the specific in ways not feasible with an ordinary bed in condition that does not constitute the need for a hospital improvedorder by to the alleviate use ofpain. a wheelchair? bed.

11. The patient requires the head of the bed to be elevated more than 30 degrees most of the time due to congestive heart failure, chronic pulmonary disease, or problems with aspiration. (Pillows and wedges must have been considered and ruled out!)

Yes,12. thereThe is patient documentation requires that tractionthe patient equipment or the caregiver that will be canable onlyto safely be operate attached the wheelchairto a hospital in the bed.home.

Yes, the patient does meet one or more of the above conditions.

No, the patient does not meet this weight criteria. Does your patient weigh ≥ 600lbs? To dispense the hospital bed an ABN stating that the patient does not meet the weight criteria and why must be completed and signed. Yes the patient’s weight is ≥ 600lbs.

The patient qualifies for a Hospital Bed.

Rev 10/4/2012

Hospital Bed

Medicare

A fully electric hospital bed is NOT covered for any reason.

A trapeze bar will be covered if the patient needs this device to sit up because of respiratory conditions, to change body position for other medical reasons, or to get in or out of bed.

Heavy duty trapezes are covered if the above criteria are met and the patient’s weight is ≥ 250 lbs.

Side rails or safety enclosures are covered when they are required by the patient’s condition and they are an integral part of, or an accessory to, a covered hospital bed.

Medicaid

Must have CyberAccess Pre-Certification done by ordering physician. A detailed order is required including duration of need.

Fully electric beds are non-covered.

Heavy duty beds must be approved through exception.

BCBS/Anthem Missouri Plans

. Medically Necessary: Fixed height hospital bed is considered medically necessary if one or more of the following criteria are met: 1. The individual has a medical condition that requires positioning of the body in ways not feasible with an ordinary bed to alleviate pain, prevent contractures, promote good body alignment or avoid respiratory infections. 2. The individual requires the head of the bed to be elevated more than 30 degrees most of the time due to congestive heart failure, chronic pulmonary disease, or problems with aspiration. Pillows or wedges must have been considered and ruled out. Elevation of the head/upper body less than 30 degrees does not usually require the use of a hospital bed. 3. The individual requires special attachments, such as traction equipment, that can only be attached to a hospital bed. Variable height hospital bed is considered medically necessary if the individual meets one or more of the criteria for a fixed height hospital bed and requires a bed height different than a fixed height hospital bed to permit transfers to chair, wheelchair, or standing position. This includes, but is not limited to: 1. Severe arthritis 2. Fractured hips or other lower extremity injuries 3. Spinal cord injuries 4. Severe cardiac conditions 5. Stroke

Rev 10/4/2012

Hospital Bed

BCBS/Anthem Missouri Plans (cont.) Semi-electric hospital bed is considered medically necessary if the individual meets one or more of the criteria for a fixed height bed and requires frequent changes in body position or has an immediate need for a change in body position. Heavy-duty, extra-wide hospital bed is considered medically necessary if the individual meets one or more of the criteria for a fixed height hospital bed and the individual's weight is more than 350 pounds, but does not exceed 600 pounds. Extra heavy-duty hospital bed is considered medically necessary if the individual meets one or more of the criteria for a hospital bed and the individual's weight exceeds 600 pound

UHC A detailed order is required prior to dispensing.

Semi-Electric beds are covered but tracked through case management so prior authorization can be completed before rental rolls $1,000. Fully-Electric hospital beds must be approved through an exception process.

CoxHealth

A detailed order is required prior to dispensing. Semi-electric hospital bed is covered. Fully-electric hospital bed is not covered.

Rev 10/4/2012