Article Detail - JA DME
Enteral and Parenteral Nutrition Refill Requirements
Suppliers must stay attuned to the beneficiary's use of DMEPOS supplies and rental items. For the ongoing use of supplies and rental DME, the medical records must support the level of care provided and ensure that the items dispensed to the beneficiary are and continue to be reasonable and necessary. While obtaining regular or routine refill prescriptions is not required, it may support continued medical need.
When the beneficiary obtains items at a retail location, the itemized sales receipt is considered a request for refill. When items are delivered to the beneficiary, the supplier must be in contact with the beneficiary for the items to be refilled, monitor use, and ensure the items requested remain reasonable and necessary. The request for refills must be specific to the beneficiary's needs and supported by the medical records. While Medicare does not define how the supplier and beneficiary communicate the need for a refill, it is required that the supplier document the request. The request must contain all the elements below.
- Beneficiary's name or authorized representative, if different from the beneficiary
- A description of each item requested
- Documentation of an affirmative response indicating a need for refill
- Date of refill request
Remember, it is not appropriate to obtain a retrospective attestation that the refill is warranted; the request must be obtained prior to shipping. Effective January 1, 2024, suppliers must contact the beneficiary no sooner than 30 days before the end of the current supply and document an affirmative response. Suppliers are no longer required to document the quantity on hand. Items dispensed on or prior to December 31, 2023, must have documented refill requests within 14 days of the refill and must include the remaining quantity of DME items or supplies.
Refill requirements are not applicable to the enteral daily supply allowances for HCPCS codes B4034, B4035, B4036, and B4148 or the parenteral nutrition supply allowances for HCPCS codes B4220, B4222, and B4224. These codes are considered all-inclusive and include all supplies required for the administration of nutrition to the beneficiary for one day.
For the nutrients themselves, suppliers must have contact with the beneficiary prior to dispensing refills. Effective January 1, 2024, this contact must occur within 30 days. Refills may not be automatically dispensed without a request for refill from the beneficiary. A reminder that the supplier may not ship or deliver the products sooner than 10 days prior to the exhaustion of supplies or nutrients on hand. Refilled items must be reasonable and necessary. Detailed records should be kept recording contact between the supplier and beneficiary. If the beneficiary has not used all their previously delivered nutrients or supplies, the supplier should either delay delivery of the next shipment or reduce the quantity delivered so there is no more than one month's supply on hand at any one time. This may occur in situations in which the beneficiary was admitted to the hospital or in which the beneficiary did not receive their usual nutrient intake because of an acute illness or similar circumstances.
