Transitioning Beneficiaries Fact Sheet
On April 9, 2020, the non-invasive ventilators product category was removed from Round 2021 due to the novel COVID-19 pandemic. On October 27, 2020, the Centers for Medicare & Medicaid Services (CMS) announced the single payment amounts and began offering contracts for the off-the-shelf (OTS) back braces and OTS knee braces product categories. All other product categories were removed from Round 2021. Please see the CMS announcement for additional information.
A beneficiary who is renting durable medical equipment (DME) or oxygen and oxygen equipment may switch to a contract supplier at any time during Round 2021 of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. The following are examples of why a beneficiary may change suppliers:
- Beneficiary or caregiver decides to change suppliers
- Beneficiary moves and must change suppliers
- Current supplier no longer in business
- Termination of current supplier’s competitive bidding contract
- Beneficiary changes from a Medicare Advantage plan to Original Medicare
- Current supplier was not awarded a competitive bidding contract and decided not to become a grandfathered supplier
In the event a beneficiary changes suppliers, the current supplier who is transitioning the beneficiary to a contract supplier should pick up its rental equipment after making arrangements with the new contract supplier for the delivery of new rental equipment. Both suppliers should be sure that these arrangements meet the beneficiary’s needs and do not cause any disruption in service. If necessary, the current supplier should assist the beneficiary in locating a new contract supplier. Contract suppliers are obligated by the terms of their competitive bidding contract to accept the Medicare beneficiary as a customer.
Pick-Up and Delivery Process
The current supplier’s pick-up of its existing rental equipment and the delivery of new rental equipment from the new contract supplier should occur on the monthly anniversary date of when the rental equipment was first delivered to the beneficiary by the current supplier, unless another date is agreed upon by the beneficiary. The monthly anniversary date is the day when a new monthly rental period begins. For example, if the rental equipment was first delivered to the beneficiary on March 27th, the monthly anniversary date would be the 27th of each subsequent month.
Billing and Documentation Guidelines
Medical documentation requirements apply when transitioning a beneficiary to a new supplier. The new contract supplier should acquire all supporting documentation, such as the physician order or the certificate of medical necessity form, when applicable, from the current supplier. Please see Chapter 5 of the Centers for Medicare & Medicaid Services' (CMS’) Program Integrity Manual or contact your DME Medicare Administrative Contractor (MAC) for specific guidance.
Transitioning from a Grandfathered Supplier to a Contract Supplier
Beneficiaries who are receiving their competitively bid rental equipment from a grandfathered supplier may choose to transition to a contract supplier at any time. In these situations, the contract supplier may be entitled to additional payments depending on the type of equipment. For more information, please refer to the Grandfathering for Non-Contract Suppliers fact sheet.