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Good News for Beneficiaries Switching Suppliers

Posted on in Billing/Reimbursement

By Ronda Buhrmester and Dan Fedor, VGM Reimbursement Experts

When a Medicare beneficiary transitions to a new supplier, the DME MACs currently do not accept medical documentation from the original supplier. As we all know, this has been a burden on both the beneficiary and the new supplier. Change is about to happen.

Effective April 24, 2017, the DME MACs WILL accept medical documentation from the original supplier when a beneficiary transfers to a new supplier.  

What Does This Mean for the New Supplier?

This means that, when a beneficiary switches to a new supplier and as long as the new supplier receives medical documentation and timely orders that comply with Medicare requirements from the original supplier or eligible practitioner, the new supplier does not need to get a new order or new medical documentation. 

Please be sure the current requirements are met (LCDs, standard documentation language, articles, etc.). If the medical documentation, original order, or both do not meet current Medicare requirements, a new order, new visit, and retrieval of any other information may be necessary.

When a New Order IS Required

Be aware that a new order is required in the following situations:

  • 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 specified as so in the documentation section of a particular medical policy.
  • When an item is replaced.
  • When there is a change in the supplier and the new supplier did not obtain a valid order for the DMEPOS item from the original supplier.

Change Request 9886 and MLN article MM9886 state that this change is due to DMEPOS industry comments on the burdensome of documentation responsibilities on suppliers.

This a positive development for DME supplier community.

As always, should you have questions about this change, please contact us at the information below:

Ronda Buhrmester - ronda.buhrmester@vgm.com - 888-665-6518

Dan Fedor - dan.fedor@vgm.com - 844-794-8459