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For discharge planners and case managers

Fast-track a surface against a discharge date

You have a date, a patient who cannot go home onto an ordinary mattress, and a wound-care note specifying a therapy surface. What you need from a supplier is a straight answer about whether the surface can be there, what it will cost and who pays — early enough to change the plan if the answer is no.

This page gives you two things. The documentation path for getting equipment approved, written out properly, because it is the question that comes up most and is most often answered badly. And an honest account of where a Dolphin® FIS® surface sits relative to that path, which is outside it, and what that means for your patient.

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A hand holding a pen over a blank notepad, beside a face-down phone and a coffee mug on an office desk.
Working a discharge date from the desk
Covered DME path
Face-to-face, Standard Written Order, documentation, proof of delivery
Dolphin FIS
Private rental or purchase — no HCPCS code of its own
We do not bill
Medicare, Medicaid or commercial plans
Best time to ask
When the surface is first discussed, not when the date is set

How to get equipment approved, step by step

  1. 1

    Face-to-face evaluation

    The treating practitioner evaluates the patient and documents the condition the equipment addresses. For support surfaces, that documentation is about the ulcer, its stage and location, and the treatment program to date.

  2. 2

    Standard Written Order

    Medicare requires that a Standard Written Order be communicated to the supplier before a claim is submitted. Getting it right the first time is the difference between a delivery and a denial.

  3. 3

    Medical-necessity documentation

    The record has to show the criteria are met — for a Group 2 surface, the comprehensive treatment program, the assessments, the turning and positioning, the wound care, the moisture management and the nutritional intervention.

  4. 4

    Supplier delivery and proof

    The DME supplier delivers and retains proof of delivery. For continued use of a Group 3 surface, the practitioner re-evaluates and recertifies the need monthly.

  5. 5

    And the parallel track

    If the surface specified is a Dolphin FIS, none of the above applies, because it is not a covered benefit. It is rented or bought privately, which is faster to arrange and paid for differently.

How to get approved for a hospital bed or a therapy surface

The covered-equipment path has four parts and they are the same for a bed as for a support surface: a face-to-face evaluation by the treating practitioner that documents the need, a Standard Written Order communicated to the supplier before any claim is submitted, medical-necessity documentation in the record that matches the coverage criteria for the item, and delivery by an enrolled supplier who retains proof of delivery.

For pressure-reducing support surfaces, the criteria are specific enough to plan against. Medicare covers a Group 2 surface where the beneficiary meets at least one of three conditions: multiple stage 2 ulcers on the trunk or pelvis that have failed to improve over the past month while the patient has been on a comprehensive ulcer treatment program; large or multiple stage 3 or stage 4 ulcers on the trunk or pelvis; or a myocutaneous flap or skin graft for an ulcer on the trunk or pelvis within the past 60 days, where the patient was on a Group 2 or Group 3 surface immediately before a discharge within the past 30 days.

That third criterion is the one discharge planners use most and lose most often, because it has two clocks running in it — 60 days since the flap or graft, 30 days since the discharge — and because it requires the record to show what surface the patient was on before they left. If that is your patient, make sure the pre-discharge surface is documented while they are still in the building.

A Group 3 surface, the air-fluidized bed, has its own and much longer list, including that without it the patient would require institutionalization, that a trained adult caregiver is available, that conservative treatment has run for at least a month without progression toward healing, and that the practitioner re-evaluates and recertifies monthly. The insurance section sets all of it out.

Where a Dolphin FIS surface sits, and why that is simpler

Fluid immersion simulation has no HCPCS code of its own. The Group 3 code, E0194, is defined by a specific mechanism — warm filtered air circulated through silicone-coated ceramic beads — and a Dolphin FIS is not that. Joerns describes its system as delivering many of the best elements of air-fluidized therapy, which is a comparison rather than an equivalence, and we will not stretch it into one. At least one major commercial payer classifies fluid immersion simulation as experimental, investigational or unproven and considers it institutional equipment inappropriate for home use.

So there is nothing to approve. We do not bill Medicare, Medicaid or commercial plans, and we do not submit claims. A Dolphin FIS surface is rented monthly or bought outright by the family, on a facility purchase order, or through a VA health network’s contracting process. That removes an authorization cycle from your timeline, and it puts a private cost in front of a family that may not be expecting one.

Both halves of that need saying to the family in the same sentence. Our experience of this is that planners who set the expectation early get better decisions than planners who let a family assume coverage and find out at delivery.

Working to a discharge date

Send the request as soon as the surface is discussed, not when the date is confirmed. A request already on the desk when the date firms up has options a request made that afternoon does not. Dates move in both directions and we would far rather hold a configuration and stand down than compress a lane.

The receiving end is what decides whether a discharge works. A therapy surface needs a bed frame under it, and a Dolphin surface has fixed dimensions: 35, 42 and 48 inch widths, 82 inch lengths with an 88 inch step-deck version and an expandable model rated 80 to 92 inches, in 8 or 10 inch depths. Joerns states that the equipment is not to be used where gaps of even a few inches are left between the surface and the head panel, foot panel or rails. If the home has no frame yet, or an unknown one, that is the first thing to resolve — often with a local DME supplier for the frame while the surface comes from us.

We do not publish a delivery-time guarantee. What you get instead is a stock answer, a lane answer and the earliest date the carrier will commit to, in writing, before you build a discharge around it. If the honest answer is that it will not make your date, you will hear that while there is still time to plan differently.

  • The discharge date, and what it is contingent on
  • The surface specified, or the clinical requirement it must meet
  • Whether a bed frame is already in the home, and its make, model or measurements
  • The patient’s approximate weight
  • Whether the patient is going home, to a family member’s home, or to a facility
  • Who is paying, and whether they know the figure yet
  • The household contact and the address, including the floor and access

Discharging to a facility rather than a home

A transfer to a skilled nursing facility or a long-term care bed changes who is buying, not what is being supplied. The facility’s own procurement process applies, the receiving arrangements are a dock rather than a doorway, and clinical engineering may want to receive and log the unit before it reaches a room.

Tell us early which it is, because it changes the quote and the paperwork. It also changes who we talk to: families make decisions on the phone in an evening, and facilities make them on a purchase order in a week. A discharge planner who tells us which world we are in on day one saves everybody a round of confusion.

What we will not do

We will not tell a family that a Dolphin FIS surface is covered, eligible, billable or likely to be reimbursed. None of those are true, and a family told otherwise finds out at the worst possible moment.

We will not substitute a configuration for the one a clinician specified without going back to the clinician. We will not write a Letter of Medical Necessity, which is your side’s document and not ours. And we will not quote a delivery clock we cannot stand behind in order to win a placement against a date.

Send this with an express request

  • Patient’s approximate weight and the clinical requirement or specified configuration
  • The discharge date and what it depends on
  • Destination: home, family home, or facility — with the receiving contact
  • Bed frame at the destination: make and model, or measured deck width and length
  • The frame’s rated load capacity if it is known
  • Whether a frame still needs to be sourced, and by whom
  • Who is paying: family, facility purchase order, or VA process
  • Full delivery address including floor, entrance or dock, and access constraints
  • Your name and the best way to reach you as the date approaches

Send an express request

Hospital and discharge
Patient, family contact and delivery
Equipment recommended

Share what we need to deliver and set up safely. Please leave out diagnoses and clinical history we do not need.

Questions people ask us

How do you get approved for a hospital bed?
Through the covered-DME path: a face-to-face evaluation by the treating practitioner documenting the need, a Standard Written Order communicated to the supplier before any claim is submitted, medical-necessity documentation in the record matching the item’s coverage criteria, and delivery by an enrolled supplier who retains proof of delivery.
Does that path apply to a Dolphin FIS surface?
No. Fluid immersion simulation has no HCPCS code of its own and a Dolphin FIS is not an air-fluidized bed, so there is no benefit to approve. It is rented or bought privately, on a facility purchase order, or through VA contracting. We do not bill Medicare or submit claims.
What are the Group 2 criteria my documentation has to meet?
At least one of: multiple stage 2 ulcers on the trunk or pelvis that failed to improve over the past month on a comprehensive treatment program; large or multiple stage 3 or 4 ulcers on the trunk or pelvis; or a myocutaneous flap or skin graft for such an ulcer within the past 60 days with a Group 2 or 3 surface immediately before a discharge in the past 30 days.
How quickly can you deliver for a discharge?
We check stock, the lane and the carrier’s cutoff and give you the earliest date the carrier will commit to, in writing. We do not publish a delivery guarantee, and if the honest answer is that it will not make your date you will hear that while you can still plan around it.
Can you deliver to the hospital instead of the home?
Yes, with the dock, the receiving hours, the department and whether clinical engineering needs to receive it first. Campus deliveries need more address detail than a street line or they sit on a dock.
What if the family cannot afford it?
Say so early and we will tell you plainly whether renting monthly changes the picture. If the patient meets the criteria for a covered Group 2 surface, that route is coded and billable through an enrolled DME supplier, and it is the better answer. We would rather point you there than take an order a family cannot sustain.
Does the patient need a hospital bed as well as the surface?
They need a bed frame for the surface to lie on. Joerns states the system is customizable to fit bed frames, including bariatric frames, up to 48 inches wide, and that it must not be used where gaps are left at the panels or rails. The frame is often the part a covered benefit will pay for, through a different supplier.

Send an express request

Give us the date, the requirement and the destination. You will get stock, fit, cost and the earliest realistic receipt in writing — including an honest no, in time to change the plan.

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