HALIFAX, Va., Aug. 15, 2012—According to the National Association of Independent Medical Equipment Suppliers (NAIMES), National Government Services—the Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC)—would like to remind durable medical equipment prosthetics, orthotics and supplies (DMEPOS) suppliers that in order to obtain and retain billing privileges they must follow all 30 supplier standards.
Recently, National Government Services has received questions regarding supplier standard five which states the following: “A supplier must advise beneficiaries that they may rent or purchase inexpensive or routinely purchased durable medical equipment and of the purchase option for capped rental equipment.”
Suppliers should be aware of the “supply” type items that also fall within the inexpensive or routinely purchased (IRP) durable medical equipment payment category, including positive airway pressure (PAP) accessories, glucose test strips, etc. Even though these “supply” type items are always purchased they do fall within the IRP payment category. Therefore suppliers are required to offer the beneficiary the option of renting these supply items. Suppliers are required to give the beneficiary, in writing, the option of renting or purchasing all items within the IRP payment category. If the supplier fails to do so they are in direct violation of supplier standard number five.
NAIMES and numerous others protested this “completely bizarre notice” requiring suppliers to offer a rental option on supply items that are one-time, single-patient use items. The DME MAC rescinded the notice and then issued a replacement notice earlier this week titled “Supplier Standard #5-Guidelines and Requirements.”
National Government Services, the Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC) published an article on Wednesday, August 8, 2012, titled “Reminder: Supplier Standard #5-Rent/Purchase Option Language”, which was rescinded on Friday, August 10th. This article replaces the previously rescinded article and provides clarification on durable medical equipment prosthetics, orthotics and supplies (DMEPOS) supplier standard five. DMEPOS suppliers are also reminded that in order to obtain and retain billing privileges they must follow all 30 supplier standards.
Inexpensive or Other Routinely Purchased (IRP) Durable Medical Equipment
Suppliers are required to inform the beneficiary, in writing, that Medicare will pay for the rental or purchase of inexpensive or routinely purchased durable medical equipment (i.e., glucose monitors, positive airway pressure (PAP) humidifiers, walkers, etc.). If the supplier fails to do so they are in direct violation of supplier standard number five. However, a supplier may choose to provide the item under only one of these options (i.e., rental or purchase). A supplier is not required to offer both options. For example, if a supplier chooses only to sell, not rent, a glucose monitor, then the informed beneficiary has the option to go elsewhere if rental of the equipment is preferred.
Accessories used in conjunction with durable medical equipment (i.e., glucose test strips, PAP accessories) may also fall within the IRP payment category but are considered disposable and therefore supplier standard five does not apply.
Capped Rental Items
Payment for items in this category may not exceed a period of continuous use longer than 13 months. After 13 months of rental have been paid, the beneficiary owns the DME item, and after that time Medicare pays for reasonable and necessary maintenance and servicing (i.e., parts and labor not covered by a supplier’s or manufacturer’s warranty) of the item. This provision applies to beneficiaries renting an item for which the first rental month is on or after January 1, 2006.
The National Supplier Clearinghouse (NSC) has a recommended letter that suppliers may use to notify beneficiaries of their option to rent or purchase IRP items and of the purchase option for capped rental equipment. The recommended letter is titled, “Medicare Capped Rental and Inexpensive or Routinely Purchased Items Notification for Services on or after January 1, 2006” and can he found here.
NAIMES leadership contacted CMS senior leadership directly on this issue and thanks the Ohio Association of Medical Equipment Services (OAMES) for their efforts on this matter. Learn more at www.dmehelp.org.
