Tip sheet explains referrals, grandfathered suppliers for DMEPOS program

May 30, 2008

There is a new tip sheet available for referral agents and grandfathered supplieres under the DMEPOS competitive bidding program.

Medicare providers in the 10 competitive bidding areas (CBAs) who order or refer Medicare beneficiaries for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) can now access a tip sheet that describes the DMEPOS competitive bidding program and outlines the important role they will play as someone who may assist beneficiaries residing in or traveling to CBAs. Since those who won the bids will get the business starting July 1, there is only about a month's time left for the transition. Many beneficiaries will be required to transition to a contract supplier. For some items, Medicare beneficiaries can choose to continue their relationship with their current suppliers.

In addition, non-contract suppliers in the 10 competitive bidding areas can now access a tip sheet that describes the actions DMEPOS suppliers need to take to become a grandfathered supplier. A grandfathered supplier is a non-contract supplier that elects to continue to provide certain rented DME or oxygen and oxygen equipment at the time a competitive bidding program begins in a CBA. Payment for grandfathered items furnished during the initial competitive bidding program varies depending on the payment category to which the item(s) belongs. In all cases, assignment of claims is mandatory, and suppliers must accept the Medicare allowed payment amount as payment in full.

The tip sheet includes a link to a sample beneficiary notice form that can be used to meet the recommended 30-day advance notification to beneficiaries regarding a supplier's decision to become (or not become) a grandfathered supplier. Supplier notice to Medicare beneficiaries should occur by June 1 to give adequate time should the beneficiary elect or need to transition to a contract supplier. Both tip sheets can be found at www.cms.hhs.gov/DMEPOSCompetitiveBid.

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