Medicare

(818) 845-7488

Aamcare Electropedic

907 Hollywood Way, Burbank CA 91505

NPI#: 0801270001

Lift Chair Paperwork Requirements (Medicare Billing Code: E0627NU)

  1. Initial Intake
  2. Medicare Card (Part B, Secondary Copayment Insurance)
  3. Dr. Rx
  4. CMN - Certificate of Medical Necessity (#4 Once Standing, does the patient have the ability to ambulate?  Answer Must be Yes!)
  5. NO ASSIGNMENT OF BENEFITS (Check Goes Direct to Customer)
  6. (Protocal for Resolving Complaints)
  7. ABN Advance Beneficiary Notice
  8. Driver Instructions
  9. Delivery Ticket Signed by both Customer & Driver
  10. Equipment Warranty Information Form
  11. Patient Satisfaction Survey
  12. Acknowledgement of Receipt by Patient Form

 

Hospital Bed

  1. Initial Intake
  2. Medicare Card (Part B, Secondary Copayment Insurance)
  3. Dr. Rx
  4. Chart Notes
  5. Assignment of Benefits
  6. Capped Rental
  7. (Protocol for Resolving Complaints)
  8. ABN Advance Beneficiary Notice
  9. Driver Instructions 
  10. Delivery Ticket Signed by both Customer & Driver
  11. Equipment Warranty Information Form
  12. Patient Satisfaction Survey
  13. Acknowledgement of Receipt by Patient Form

Scooters & Power Wheelchairs

  1. Initial Intake/Measuring Guide
  2. Medicare Card (Part B, Secondary Copayment Insurance)
  3. Authorization For Release of Medical Info
  4. Face to Face, Chart Notes Documenting Face to Face, Last 45 Days
  5. Dr. Rx
  6. (Protocal for Resolving Complaints)
  7. ABN Advance Beneficiary Notice
  8. Driver Instructions: Assesment of Living Area/Home Evaluation (DRIVER CAN DO)
  9. Delivery Ticket Signed by both Customer & Driver
  10. Equipment Warranty Information Form
  11. Patient Satisfaction Survey
  12. Acknowledgement of Receipt by Patient Form


Patient Intake p.df.pdf13.9 KB Patient Intake p.df.pdf13.9 KB Patient Intake p.df.pdf13.9 KB Patient Intake p.df.pdf13.9 KB
CMS849.pdf98.5 KB CMS849.pdf98.5 KB

SPAN AMERICA Support Surface Reimbursement for Homecare