💙 Specialized Support Facilities DME & Insurance

Insurance & DME Guidance for Facilities This program provides clear, easy-to-understand guidance to help facilities navigate Medicare, Medicare Advantage, and private-pay requirements for durable medical equipment (DME). Staff learn what equipment is covered, what is not, and how to support residents and families through the decision and approval process. Understanding Medicare Coverage We explain what Medicare typically covers, what it does not cover, and the medical-necessity criteria used to determine eligibility. This helps staff know when a resident may qualify and when alternative options are needed. Medicare Advantage Plans Facilities learn how Advantage plans differ from Traditional Medicare, how prior authorizations work, and which items are commonly denied. This prepares staff to guide families through longer or more complex approval timelines. Documentation Essentials We outline the key documentation required for DME approval—physician notes, diagnoses, and face-to-face visits—so facilities can help gather accurate information and reduce delays. Facility Role vs. Provider Role This section clarifies what the facility can and cannot submit, what the prescribing provider must handle, and when the DME supplier becomes involved. It helps staff stay compliant while assisting residents effectively. Private-Pay Scenarios Some items are never covered by insurance. Staff learn which products fall into this category—such as fully electric beds, Broda chairs, ramps, stairlifts, and specialty mattresses—so they can provide clear guidance and prevent confusion. Educating Families We teach facilities how to communicate coverage limits, set realistic expectations, and help families avoid unsafe or inappropriate online purchases. The goal is to make equipment decisions smoother, safer, and more informed, videos of different equipment categories.