WASHINGTON, June 14, 2012—The Centers for Medicare & Medicaid Services has done an about-face on DMEPOS items provided on a recurring basis. CMS now states that billing must be based upon prospective instead of retrospective use.
Essentially, that means providers of refills to an original order must now contact beneficiaries before dispensing refills. They may no longer automatically ship on a predetermined basis, even if the beneficiary authorizes it.
The National Association of Independent Medical Equipment Suppliers (NAIMES) called it a “flawed policy that could have a significant impact on supplier costs.” The Accredited Medical Equipment Providers of America (AMEPA) said the new rule would likely add more costs and headaches for providers.
The change came in a CMS notice published June 8. It revises requirements for refills effective for dates of service on or after Aug. 2, 2011, NAIMES reported.
The Local Coverage Determinations affected by these requirements were listed as: automatic external defibrillators, enteral nutrition, external breast prostheses, external infusion pumps, glucose monitors, immunosuppressive drugs, intravenous immune globulin, nebulizers, negative pressure wound therapy, oral anticancer drugs, oral antiemetic drugs, ostomy supplies, oxygen (for billable contents), parenteral nutrition, positive airway pressure devices, respiratory assist devices, suction pumps, surgical dressings, tracheostomy supplies, transcutaneous electrical nerve stimulators (TENS) and urologic supplies.
