| NHIC, Corp.DME MAC A ListServe | For Immediate Release |
March 26, 2009
Beneficiary Request for Refill of Supplies, Accessories, and DrugsThe Medicare Claims Processing Manual, Chapter 20, Section 200 states:Suppliers/manufacturers may not automatically deliver DMEPOS to beneficiaries unless the beneficiary, physician, or designated representative has requested additional supplies/equipment. The reason is to assure that the beneficiary actually needs the DMEPOS. A beneficiary or their caregiver must specifically request refills of repetitive services and/or supplies before a supplier dispenses them. A supplier may not initiate a refill of an order. The supplier must not automatically dispense a quantity of supplies on a predetermined regular basis.Furthermore, the Medicare Program Integrity Manual, Chapter 4, Section 4.26.1 states:For DMEPOS products that are supplied as refills to the original order, suppliers must contact the beneficiary prior to dispensing the refill. Contact with the beneficiary or designee regarding refills should take place no sooner than approximately 7 days prior to the delivery/shipping date. For subsequent deliveries of refills, the supplier should deliver the DMEPOS product no sooner than approximately 5 days prior to the end of usage for the current product.Beneficiaries cannot "authorize" in advance the routine dispensing of DMEPOS items. Also, because of the time frames specified, the request for subsequent delivery cannot be made at the time of or soon after the current delivery of items. For example, when a beneficiary receives a supply of glucose test strips, it would not be acceptable for the beneficiary to tell the supplier at that time to deliver a new supply of test strips in 1-3 months.Suppliers should document the request for a refill. This could be documented in a number of ways, including but not limited to, a postcard signed and dated by the beneficiary, written record of phone conversation between the supplier and beneficiary/caregiver, etc. The documentation must be available on request. |
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