Choosing the Right Catheter: Tips & Learning Resources

Choosing the right catheter depends on a wide range of elements such as your gender, weight, age, manual mobility, urethral sensitivity and visual impairment. In addition to that, it may also depend on how often you travel and how physically active you are. As your trusted catheter supplier, we want to help you stay up to date on all the most recent technology, insurance and health information.

Tips for Customer Safety & Hygiene

 Know the basics:

• Keep your supplies within reach.
• Keep your supplies out of direct sunlight and away from direct heat sources.
• Do NOT wash and reuse medical supplies that are designated as SINGLE USE ONLY.
• Specifically, Do NOT wash and reuse intermittent catheters.
• If bleeding or pain occurs at the insertion site, please call your physician or 911. ABC Medical is not a replacement for your physician.
• If you have any questions on how to use your supplies, please contact your physician or the manufacturer of the product.
• Always wash your hands before using your supplies.
• Do not lift heavy boxes.

When washing hands with soap and water:

• Wet your hands with clean running water and apply soap. Use warm water if it is available.
• Rub hands together to make lather and scrub all surfaces.
• Continue rubbing hands together for 15-20 seconds. Need a timer? Imagine singing “Happy Birthday” twice through to a friend.
• Rinse hands well under running water.
• Dry your hands using a paper towel or air dryer. If possible, use your paper towel to turn off the faucet.
• Always use soap and water if your hands are visibly dirty.

*If soap and clean water are not available, use an alcohol-based hand rub to clean your hands. Alcohol-based hand rubs significantly reduce the number of germs on skin and are fast-acting.

When using an alcohol-based hand sanitizer:

• Apply product to the palm of one hand.
• Rub hands together and rub the product over all surfaces of hands and fingers until hands are dry. Customer Education

Symptoms of UTI

You should see your doctor if you have any of these signs or symptoms:

• Burning feeling when you urinate
• Frequent or intense urges to urinate, even when you have little urine to pass
• Pain in your back or lower abdomen
• Cloudy, dark, bloody, or unusual-smelling urine
• Fever or chills

How to Prevent Getting a UTI?

Many people who cath are able to prevent a UTI by taking some important selfceare steps. If you are beginning to see symptoms of UTI, try to catheterize yourself more frequently (every 2-4 hours) and increase your fluid intake. Changing your catheter after increasing your fluids may help cut down on the number of bacteria living in your bladder since catheters can become “colonized” with the bacteria that are flushed out of your urinary tract.

Patients Rights & Responsibilities

Patient Rights:

• A patient has the right to be treated with courtesy and respect, with an appreciation of his or her individual dignity, and with the protection of his or her need for privacy.
• A patient has the right to a prompt and reasonable response to questions and requests.
• A patient has the right to know who is providing medical services and who is responsible for his or her care.
• A patient has the right to know what patient support services are available, including whether an interpreter is available if he or she does not speak English.
• A patient has the right to know what rules and regulations apply to his or her conduct.
• A patient has the right to be given by the healthcare provider
• information concerning diagnosis, planned course of treatment, alternatives, risks, and prognosis.
• A patient has the right to refuse any treatment, except as otherwise provided by law.
• A patient has the right to be given, upon request, full information and necessary counseling on the availability of known financial resources for his or her care.
• A patient who is eligible for Medicare has the right to know, upon request and in advance of treatment, whether the healthcare provider or health care facility accepts the Medicare assignment rate.
• A patient has the right to receive, upon request, prior to treatment, a reasonable estimate of charges for medical care.
• A patient has the right to receive a copy of a reasonably clear and understandable, itemized bill and, upon request, to have the charges explained.
• A patient has the right to impartial access to medical treatment or accommodations, regardless of race, national origin, religion, physical handicap, or source of payment.
• A patient has the right to treatment for any emergency medical condition that will deteriorate from failure to provide treatment.
• A patient has the right to know if medical treatment is for purposes of experimental research and to give his or her consent or refusal to participate in such experimental research.
• A patient has the right to express grievances regarding any violation of his or her rights, as stated in Florida law, through the grievance procedure of the healthcare provider or health care facility which served him or her and to the appropriate state licensing agency.

Patient Responsibilities:

• A patient is responsible for providing to the healthcare provider, to the best of his or her knowledge, accurate and complete information about present complaints, past illnesses, hospitalizations, medications, and other matters relating to his or her health.
• A patient is responsible for reporting unexpected changes in his or her condition to the health care provider.
• A patient is responsible for reporting to the health care provider
• whether he or she comprehends a contemplated course of action and what is expected of him or her.
• A patient is responsible for following the treatment plan recommended by the health care provider.
• A patient is responsible for keeping appointments and, when he or she is unable to do so for any reason, for notifying the health care provider or health care facility.
• A patient is responsible for his or her actions if he or she refuses treatment or does not follow the health care provider’s instructions.
• A patient is responsible for assuring that the financial obligations of his or her health care are fulfilled as promptly as possible.
• A patient is responsible for following health care facility rules and regulations affecting patient

What You Need to Know About Medicare Guidelines

1. If you have any questions about what is required by you as a Medicare beneficiary, call  ABC Medical toll free at 866-897-8588.
2. A prescription is required for EVERY item that we bill Medicare for on your behalf
3. All Medicare beneficiaries MUST have a face to face visit with the doctor that prescribes their supplies at least once a year (a doctor visit with your primary care physician that does not prescribe your urological supplies does NOT meet this requirement-you must visit the physician that writes your prescription for urology supplies).
4. Medicare beneficiaries MUST also see their physician any time items are added or monthly quantities change.
5. All DME providers like ABC Medical are  required by Medicare to obtain documentation from your ordering physician EVERY YEAR to prove to Medicare that the supplies being requested are still being used and are still medically required… regardless of the beneficiary’s medical condition.
   1. ABC Medical completely agrees that some conditions are permanent and are not likely to ever change; however, Medicare still requires this information to be documented at least once a year.
   2. ABC Medical will provide friendly reminder calls each reorder cycle to ensure all Medicare requirements are being satisfied so you do not need to worry about any gaps in service.
6. Medicare has a very specific fee schedule that MUST be followed by all suppliers in regards to what items are covered and what quantities are covered. Medicare does not allow beneficiaries to receive items or quantities out of convenience or preference. Everything is based on Medical Necessity. If quantities or items are found to be not medically necessity by Medicare, you could be financially responsibility for those items/quantities.
7. Medicare allows 30 day supply orders and 90 day supply orders.
8. Medicare REQUIRES that we contact you  PRIOR to each shipment to confirm the following information or they will NOT pay for your claim:
   1. What items do you need and what quantities do you need.
   2. How many times per day do you use the specific product(s) that you are requesting.
   3. How many of each item do you currently have on hand.
      1. We cannot take your order if you have more than 14 days’ worth of supplies on hand.
      2. We cannot ship your order if you have more than 10 days’ worth of supplies on hand.
   4. If we speak with someone other than the actual patient, we must:
      1. Confirm that the person placing the order is authorized to speak on your behalf; AND
      2. Obtain the name of the person we are speaking with; AND their relationship to you, the patient.

Frequently Asked Questions – Insurance Coverage

Important note: Regulations and/or your insurance may require a written prescription for your supply order.

1. Can you automatically send me my shipment each month without having to contact me?
   1. Most commercial insurances and some Medicaid insurances allow providers to send orders every 30 or 90 days.
   2. Medicare and some Medicaids, for example South Carolina, North Carolina and Georgia REQUIRE us to obtain authorization for the patient PRIOR to every shipment.
2. How frequently can you ship me my order?
   1. Medicare allows 30 day and 90 day shipments and allows us to ship 10 days prior to the patient being exhausted of supplies.
   2. Medicaid allows 1 shipment every 30 days regardless of quantities on hand.
   3. Commercial insurances typically do not have requirements, unless they follow Medicare or state Medicaid guidelines.
3. Am I allowed to receive whatever supplies and quantities that I feel are convenient and necessary?
   1. All insurances operate under a formulary that determines what items are covered and what quantities are covered; and everything is based on what the insurance company feels is Medically Necessary.
   2. Some insurance companies, such as some Medicaid and some Commercial plans, require Pre-Authorizations based on quantity, product, and/or costs.
4. What is a Pre-Authorization?
   1. A pre-authorization (PAR) is required by some insurance companies PRIOR to shipping certain items, quantities, or charges.
   2. A pre-authorization is a requirement where we must ask, prior to shipment, for the insurance company’s approval.
   3. ABC Medical will obtain all required documentation, provided you have had a face to face visit with your doctor within the insurance companies’ requirements, and file the required paperwork on your behalf.
5. If my insurance changes what should I do?
   1. You should immediately call our office so we can ensure all new insurance requirements are met and determine if any new/additional documentation is now required. All patients are responsible for notifying us of insurance changes so they do not incur additional or unnecessary financial obligations.
   2. Please be especially aware of any changes at the beginning of the year as this is typically when most plan coverages change.
   3. Some Medicaid plans will change more frequently.
6. How frequently does my insurance company require me to have a face to face visit with my ordering doctor?
   1. Medicare and most insurances: At least once a year.
   2. Georgia Medicaid: at least once a year; AND
      1. The prescription cannot be provided if the patient has not been seen within the past 6 months.
   3. This applies to all recurring orders and any new items.
      1. South Carolina Medicaid: at least once a year; AND
      2. The prescription cannot be provided if the patient has not been seen within the past 2 months.
   4. This applies to all reorders and any new items.
      1. Wound Care Orders: Monthly, in most cases.
7. What happens if I do not meet the face to face visit requirements with my doctor(s)?
   1. Your Physician cannot write a new prescription for you; AND
   2. Your insurance company will not pay for your supplies; AND
   3. We are not legally allowed to ship your order without a valid doctor’s order and office visit notes unless you are willing to personally pay for the order(s).
8. I have a permanent condition such as paraplegia, spina bifida, etc. Do I still need to meet these doctor visit requirements if I have a permanent condition such as paraplegia, spina bifida, etc.?
   1. Yes. Since insurance coverage is solely based on the insurance company’s Medical Necessity and Continued Use policies, everyone must comply with these requirements if we want the insurance company to pay your claims.