Getting a hospital bed approved

This page assumes you have read the coverage page and believe the criteria genuinely apply. If they do not, nothing here will help, and the alternatives on that page are the better use of your time.

The order of operations

1. The clinical conversation first, not the catalog. The physician has to reach the conclusion that positioning is required. Arriving with a chosen bed and asking for a signature inverts the process and is the most common way this goes wrong.
2. Establish which criterion applies. Positioning not feasible in an ordinary bed; head elevation over 30 degrees most of the time for congestive heart failure, chronic pulmonary disease, or aspiration problems; or traction equipment attachable only to a hospital bed.
3. Establish which bed type. A semi-electric bed additionally requires a documented need for frequent position changes, or an immediate need for a change in position. A fixed-height bed does not.
4. Get the order and the documentation. The clinical record has to support the criterion, not merely repeat it. A note saying the patient requires a hospital bed is not documentation; a note describing the condition and why an ordinary bed cannot meet it is.
5. Use a Medicare-enrolled supplier who accepts assignment. Confirm both, in that order, before anything is delivered.

The two mistakes that cause most trouble

Asking for the wrong product

If what is actually wanted is a comfortable bed that raises at the head, and the paperwork says hospital bed, the process will either fail or deliver something nobody wanted. A hospital bed looks like a hospital bed, and that changes a bedroom. The functional comparison is worth reading with the person who will sleep in it.

Thin documentation

The criteria are specific and the documentation has to be specific too. Restating the criterion in a note is not the same as recording the clinical facts that satisfy it. This is not something a patient can fix directly, but it is something worth knowing about, because a denial for insufficient documentation is often fixable and a denial for non-coverage is not.

What you will pay if it is approved

• 20% of the Medicare-approved amount, after the Part B deductible, with a supplier who accepts assignment.
• Rental, usually. Hospital beds are commonly capped-rental items; after 13 months of continuous use the equipment becomes yours.
• Accessories are separate. Mattresses, rails and trapeze bars have their own codes and their own criteria.

If the answer is no

A denial is not the end of the practical problem. It is worth going back to what the bed was for. If it was positioning for reflux or breathing, a wedge or a base may cover it for a fraction of a rental. If it was safety getting in and out, height and a handle are cheap and immediate. If it was that a carer needs the bed to raise and lower, no consumer product does that and rental may be worth pricing.