|
We must have the following signed, dated, original documents in our possession before you place an order if you are a Medicare Beneficiary.
1. A copy of your Medicare Card.
2. A "Patient Authorization" form. This form authorizes us to release medical and other necessary information to Medicare for the claims we submit for you. You will find a link at the top of this page titled "Patient Authorization". Please click on the link, print the page, fill out the information and return it to us with the other documents.
2. A prescription from your physician stating your name, a description of the item(s) being prescribed (i.e. AMPatch stoma covers, catheters, lubricant, skin prep., etc.), the number per usage, the number per day, the length of need, the physician's signature and signature date. This prescription will serve as your physician's order for Medicare.
3. Copies of Progress Notes from your medical chart. If you require more stoma covers and/or other supplies than what Medicare routinely covers (see below), we will require copies of Progress Notes from your medical chart which document your medical condition, the medical necessity for the stoma covers (and/or other supplies) and the quantity needed per day. The Progress Notes must rationalize the need for more than the quantity of supplies normally allowed by Medicare. If you require more than the usual monthly allowance provided by Medicare (see below), Progress Notes (from your medical chart, written by your Healthcare Provider) are the only documentation that Medicare will accept. Without this documentation, your claims will likely be denied as not medically necessary. To make this process easier, you will find a link at the top of the page titled "Record Release". This will allow us to contact your physician directly and obtain the records needed. Please print the page, fill in the information and send it to:
Austin Medical Products, Inc.
P.O. Box 1830
Conway, NH 03818
|
