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22 Apr

MEDICARE DMEPOS* POLICY UPDATE


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*Durable Medical Equipment Prosthetic Orthotics and Supplies

 

Effective April 24, 2017 Medicare no longer requires Suppliers to obtain new documentation when a Beneficiary transfers to a new Supplier.

 

What you need to know

Medicare Suppliers can now use all timely Orders and Medical Documentation even if they obtained it from the Beneficiary or another supplier. Medicare Change Request 98866 issued on March 24, 2017 and effective April 24, 2017 says, in part:

 

“The purpose of this change request (CR) is to instruct contractors to accept timely orders and medical documentation, regardless of whether the supplier received the documentation directly from the beneficiary’s eligible practitioner or from another, transferring supplier.”

 

“Contractors shall accept documentation of the beneficiary’s need for an item, regardless of whether the supplier received the documentation directly from the beneficiary’s treating physician/practitioner or as transferred from their previous supplier.”

“Contractors shall, in those instances in which the documentation is not transferred, continue to require a new order/documentation be received by the supplier from the treating physician/practitioner.”

 

What this means to you

If you are a DMEPOS Supplier and you acquire a new patient from another Supplier and can obtain that Supplier’s Orders and other documentation, Medicare will accept that documentation for your claims, assuming the documentation is valid and meets all other requirements.

 

If you are a Medical Provider/Practitioner and one of your patient’s is transferred to another DMEPOS Supplier and that new Supplier contacts you for a new Order and Medical Records, you can furnish them with the most recent order you provided to the patient’s previous Supplier, assuming it is still valid.

 

When are new Orders required?

The Medicare Program Integrity Manual, Chptr 5, Sec 5.2.7 states that a new Order is required when:

 

  • There is a change in the order for the accessory, supply, drug, etc.

 

  • On a regular basis (even if there is no change in the order) only if it is so specified in the documentation section of a particular medical policy

 

  • When an item is replaced; and

 

  • When there is a change in the supplier, if the recipient supplier did not obtain a valid order for the DMEPOS item from the transferring supplier.