MHC Medical Products Easy-Touch Specifications download pdf (Page 8)

GEMCO Medical’s

Diabetes Programs

GEMCOMedicalisanauthorizeddistributorofbrandnamediabetesproducts;specializingindiabetesprogramsfor

Durable Medical Equipment Dealers, Mail Order Providers, and Independent Pharmacies.Throughmanufacture

contracts,GEMCOgivesyouaccesstodiabetesproductsatdiscountedpricesthatarebilledtoMedicare,Medicaid

(onlyifprocessedasamedicalbenet),and/orThirdPartyMedicalBenetinsurances.Throughoutthiscatalog,there

areGEMCOitemnumberslistedinred,whichdenotesMedicare,Medicaid,MedicalBeneteligibleproducts.

Look for the Manufacture Program Box on every page for specic

details on each Manufacturer’s Diabetes Program.

Inaddition,wehavediabetesproductstomeetallofyourneeds,includingbutnotlimited

to,retailproductsforcashpatientsand/orpharmacybenetbillingandalloftheancillary

productsthatgoalongwithdiabetesmanagement.

Program Denitions

What is Medicare?

Medicareisanationwide,federallyadministeredhealthinsuranceprogramthatcoversmostpeopleage65andolder.

SomeyoungerpeoplewhoaredisabledorwhohaveEnd-StageRenalDiseasearealsoeligibleforcoverage.

What is Medicaid?

Medicaidisavailabletocertainlow-incomeindividualsandfamilieswhotintoaneligibilitygroupthatisrecognized

byfederalandstatelaw.AllofGEMCO’smanufacturecontractsareformedicalbenetMedicaidprograms.

What is Medical Benet?

MedicalBenetcanbedenedascoverageadministeredthroughatraditionalormanagedcareinsuranceplanthat

coversmedicallynecessarysuppliesandservicesthatarenotconsideredhospitalorpharmacyitems.

PrivateHealthInsurancePlanshaveseveraldierenttypesofbenets:

Hospital benets-coverin-patientandout-patientsurgeries,hospitalstays,medicalprocedures,etc.

Prescription benets -coversoralmedicationsandsomemedicationsthatareinjectedintothebody.

Medical benets-durablemedicalequipment,labwork,ushots,ocevisits,etc.

ThemajorityofmedicalbenetinsurancecarriersbillthroughHCPCScodesfordiabetesproducts.Forexample,the

billerwillusethesameHCPCScodeforallteststripsandwillgetthesamereimbursementforeachteststrip,

regardlessofwhatbranditis.Eachstatewillhaveaslightlydierentreimbursementamount,andthebillershould

checktheinsurancepolicyortheCentersforMedicare&MedicaidServiceswebsiteunderDMEPOSFeeScheduleat

www.cms.hhs.gov.

Note: Some pharmacies may use an adjudicator, and they may still bill for medical benet using the NDC

number, as long as the adjudicator changes it to the correct HCPCS code.

What is Pharmacy Benet?

PharmacyBenetbillingiswhenapharmacybillsforaproductorserviceusingtheproduct’sNDCnumber.For

example,basedontheNDCnumberandinsuranceplan,thepharmacywillgetdierentreimbursementratesfor

dierentteststripbrands.Thepharmacistwillalsochargeadispensingfee.

Medicare, Medicaid and Medical Benets

Insurance Providers Diabetes Program

Benets of a Diabetes Program

ManufactureAuthorizedProgramensuresproduct

integrity.

AuthorizedtobillMedicaidandinsuranceplansasa

MedicalBenet.

Lowercostonselectdiabetesproductsforincreased

prots.

ProgramadministeredbyGEMCOadministeredbyGE

medical,aprovenpartnerandanauthorized

ottDiabetesCareDistributor.

How to Qualify

DistributorisrequiredtosignaProgramProvider

Agreementthatoutlinesalltheconditionsofthe

Manufacturer’sDiabetesCareProgram,andwill

purchasespeciallabeled“NotForRetailSale”product

fromGEMCOMedical.

Participation Requirements

Distributormust:acceptassignmentwithMedicarefor

ManufacturerDiabetesCareProducts,haveacurrent

Medicare

ProviderNumber,cannotuse

productsforretailsale,andwillactivelypromoteManufacturer’s

DiabetesCareproductstoconsumerbase.

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MHC Medical Products Easy-Touch Specifications Page 8

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