CMS Pub. 100-08, ch. 4, § 4.7.3.1.3

FFS Beneficiaries

(Rev. 11032; Issued: 09-30-21; Effective: 10-12-21; Implementation: 11-10-21)

This section applies to UPICs. [This section is applicable to DME MACs, RACs,

SMRC, and CERT MR contractors, as noted in Ch. 5, Section 5.8.]

Medicare does not automatically assume payment for a DMEPOS item that was covered

prior to a beneficiary becoming eligible for the Medicare FFS program. When a

beneficiary receiving a DMEPOS item from another payer becomes eligible for the

Medicare FFS program, the beneficiary may continue to receive such items only if

Medicare requirements are met for such DMEPOS items. The DME MAC shall educate

the supplier community that the supplier must submit an initial or new claim for the item

and the necessary documentation to support Medicare payment, upon request, even if

there is no change in the beneficiary’s medical condition. The first day of the first rental

month in which Medicare payments are made for the item serves as the start date of the

reasonable useful lifetime and period of continuous use. The contractor shall consider

the proof of delivery requirements met for this type of beneficiary by instructing the

suppler to obtain a statement, signed and dated by the beneficiary (or beneficiary's

designee), that the supplier has examined the item. The DME MAC shall educate the

supplier that the supplier must also attest to the fact that the item meets Medicare

requirements.