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Non-Contract Suppliers

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If a beneficiary who resides in a competitive bidding area (CBA) changes from a Medicare Advantage (MA) Plan, either voluntarily or involuntarily, to Medicare fee-for-service (original Medicare), can he/she remain with his/her current managed care supplier even if the supplier is not a contract supplier for the specific competitively bid item the beneficiary receives from the supplier? Will Medicare continue to pay the supplier for the items and services?

I am a supplier and want to buy or merge with a DMEPOS competitive bidding contract supplier. Can I make the change of ownership (CHOW) contingent upon CMS’ approval of a novation agreement?

I am a non-contract supplier. If I buy or merge with a contract supplier, will CMS pay for contract items I furnish after the effective date of the change of ownership (CHOW) but before the date CMS signs the novation agreement?

Do normal utilization parameters for accessories and supplies continue to apply when a patient transitions from a non-contract supplier to a contract supplier? For example, if a patient received a new continuous positive airway pressure (CPAP) mask in month six and transitioned to a contract supplier in month seven, is the contract supplier eligible to bill for a new mask upon setup? Can the contract supplier still provide these items, or is the patient not eligible since he or she received the mask in the month prior?

If a patient using a continuous positive airway pressure (CPAP) device switches to a contract supplier during the 90-day trial period required by the Local Coverage Determination (LCD), does the contract supplier need to get the compliance data from the original provider?

When a beneficiary transitions from a non-contract supplier to a contract supplier, does a new order need to be obtained by the contract supplier?

When a beneficiary transitions to a contract supplier, would the contract supplier be required to have the patient repeat a facility-based sleep study?

When a patient renting capped rental DME from a non-contract supplier switches to a contract supplier, a new 13-month rental payment period begins. Does the 90-day trial period required by the Local Coverage Determination (LCD) start over as well?

Does the hospital exemption for the DMEPOS Competitive Bidding Program allow a hospital to bill for walkers furnished to its patients with Original Medicare on the day of an outpatient hospital service?Open in New Window

If a beneficiary has been renting a competitively bid durable medical equipment (DME) item from a supplier that does not become a contract supplier and chooses to switch to a contract supplier at the start of a competitive bidding program, what month should the new contract supplier start billing? When can the non-contract supplier pick up its equipment?

Who is responsible for repair and maintenance once an item is furnished?


last updated on 07/30/2014


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