Payment Policies

Examples of when a change of ownership (CHOW) occurs for purposes of requesting a contract be transferred. Updated on 11/17/2022 to include information on the National Provider Enrollment Eastern Region (NPEAST) and the National Provider Enrollment Western Region (NPWEST) Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) contractors.

Suppliers are prohibited from competing against themselves when submitting bids in the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program.

With the exception of skilled nursing facilities (SNFs) and nursing facilities (NFs) that become specialty suppliers, contract suppliers for the enteral nutrition product category must furnish services to beneficiaries throughout the competitive bidding area (CBA), regardless of whether a beneficiary lives in a private residence or institutional setting.

Non-contract suppliers are not eligible for Medicare Part B payment for furnishing competitively bid items in a CBA unless one or more exemptions apply.

Suppliers that are not awarded a DMEPOS Competitive Bidding contract for furnishing oxygen and oxygen equipment or rented durable medical equipment (DME) in a CBA can decide to be grandfathered suppliers for Medicare beneficiaries to whom they are furnishing these items at the time Round 2021 is implemented. Updated on 10/10/2019 to clarify the grandfathering policy for continuous use rental items.

An exception that allows hospitals to furnish certain competitively bid items in a CBA to their own patients without submitting a bid and being selected as a contract supplier.

Physicians and other treating practitioners who are enrolled as Medicare DMEPOS suppliers may furnish certain competitively bid items in a CBA to their own patients without submitting a bid and being selected as a contract supplier if specific requirements are met.

The 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 when needed to avoid an adverse medical outcome.

Individuals dually eligible for Medicare and Medicaid account for a disproportionate share of Medicare expenditures, and we anticipate that you will be furnishing services to dually eligible beneficiaries in your area. It is especially important to understand the special protections for the 7.7 million who are “Qualified Medicare Beneficiaries” and, therefore, exempt from Medicare cost-sharing charges.

This fact sheet contains important information about repairs and replacements of beneficiary-owned equipment under the DMEPOS Competitive Bidding Program.

SNFs and NFs are subject to the DMEPOS Competitive Bidding Program to the extent that competitively bid items and services are furnished to their residents under Medicare Part B.

A DMEPOS supplier is responsible for furnishing the item, billing Medicare, and coordinating the care for a beneficiary in compliance with the physician’s order and Medicare rules and guidelines. However, a DMEPOS supplier may subcontract certain services to another supplier.

All of the existing rules and regulations regarding marketing DMEPOS to beneficiaries under the fee-for-service program also apply to DMEPOS contract suppliers under competitive bidding.

Guidelines for a contract supplier that is selling a distinct company and furnishes a specific product category or services a specific competitive bidding area, and requests to transfer the portion of its contract serviced by that distinct company.

Guidelines for a contract supplier that is negotiating a change of ownership (CHOW) and requests a transfer of its entire contract.

A beneficiary who is renting DME or oxygen and oxygen equipment may switch to a contract supplier at any time during Round 2021 of the DMEPOS Competitive Bidding Program.

This fact sheet is designed to provide education to DMEPOS suppliers that provide items to Medicare beneficiaries who reside in or travel to competitive bidding areas. It includes information on how to determine whether a beneficiary is in a traveling status, how to properly bill Medicare for the item, and how Medicare will determine the payment amount.