Article Detail - JA DME

Supplies or accessories with usual maximum quantities and frequency limits are typically defined in the related Local Coverage Determination (LCD) or Policy Article (PA). Suppliers must not dispense a quantity of supplies exceeding a beneficiary's expected utilization. Reordering of supplies and accessories is based upon actual beneficiary usage. Suppliers should stay attuned to atypical utilization patterns on behalf of their clients and verify with the ordering practitioner that the atypical utilization is warranted.

A beneficiary or their caregiver must specifically request refills of supplies before they are dispensed. The supplier must not automatically dispense a quantity of supplies on a predetermined basis, even if the beneficiary has "authorized" this in advance. As referenced in the Program Integrity Manual (CMS Internet Only Manual (IOM), Publication 100-08, Medicare Program Integrity Manual, Chapter 5, Section 5.2.6), "Contact with the beneficiary or designee regarding refills must take place no sooner than 14 calendar days prior to the delivery/shipping date. For delivery of refills, the supplier must deliver the DMEPOS product no sooner than 10 calendar days prior to the end of usage for the current product."