CMS Pub. 100-04, ch. 20, § 200

Suppliers/manufacturers may not automatically deliver DMEPOS to beneficiaries unless

the beneficiary, physician, or designated representative has requested additional

supplies/equipment. The reason is to assure that the beneficiary actually needs the

DMEPOS. DME MAC review should be done on a post-pay basis.

A beneficiary or their caregiver must specifically request refills of repetitive services

and/or supplies before a supplier dispenses them. A supplier may not initiate a refill of

an order. The supplier must not automatically dispense a quantity of supplies on a

predetermined regular basis.

A request for refill is different than a request for a renewal of a prescription. Generally,

the beneficiary or caregiver will rarely keep track of the end date of a prescription.

Furthermore the physician is not likely to keep track of this. The supplier is the one who

will need to have the order on file and will know when the prescription will run out and a

new order is needed. It is reasonable to expect the supplier to contact the physician and

ask for a renewal of the order. This is consistent with the DME MAC Supplier Manual

for the particular jurisdiction, which states: "The description of the item (on an order)

may be completed by someone other than the physician (most commonly the supplier).

However, the physician must review the order and sign and date it to indicate

agreement." Again the supplier must not automatically mail or deliver the DMEPOS to

the beneficiary until specifically requested.

The DME MACs inform suppliers of these procedures via their bulletins and training

sessions. These procedures will benefit suppliers by helping to maximize claims

processing accuracy, and to reduce the likelihood of a postpayment claim denial because

the DMEPOS were not medically necessary.

DME MACs must publish this information on their Web sites and in their bulletins on an

annual basis.