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Prescription for Specific Brand or Mode of Delivery to Avoid an Adverse Medical Outcome Fact Sheet

The Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program includes a special beneficiary safeguard to ensure that beneficiaries have access to specific brands or modes of delivery of competitively bid items in the product category when needed to avoid an adverse medical outcome. This safeguard, which is sometimes called the Physician Authorization Process, allows a physician (including a podiatric physician) or treating practitioner (i.e., a physician assistant, clinical nurse specialist, or nurse practitioner) to prescribe a specific brand or mode of delivery to avoid an adverse medical outcome. The physician or treating practitioner must document in the beneficiary’s medical record the reason why the specific brand or mode of delivery is necessary to avoid an adverse medical outcome.

If a physician or treating practitioner prescribes a particular brand or mode of delivery for a beneficiary to avoid an adverse medical outcome, the contract supplier must, as a term of its contract, ensure that the beneficiary receives the needed item(s). The contract supplier has three options:

  1. The contract supplier can furnish the specific brand or mode of delivery as prescribed.
  2. The contract supplier can consult with the physician or treating practitioner to find another appropriate brand of item or mode of delivery for the beneficiary and obtain a revised written prescription.
  3. The contract supplier can assist the beneficiary with locating a contract supplier that will furnish the particular brand of item or mode of delivery prescribed by the physician or treating practitioner.

If the contract supplier does not ordinarily furnish the specific brand or mode of delivery and cannot obtain a revised prescription or locate another contract supplier that will furnish the needed item, the contract supplier MUST furnish the item as prescribed.

It is important to know that any change in a prescription requires a revised written prescription. A contract supplier is prohibited from submitting a claim to Medicare if it furnishes an item different than what is specified in the written prescription received from the beneficiary’s physician or treating practitioner. Medicare will pay the single payment amount for covered competitively bid items in the product category furnished through the Physician Authorization Process.



last updated on 05/07/2019

 

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