Beneficiaries Entering Medicare - JD DME
Beneficiaries Entering Medicare
Equipment Retained from a Prior Payer
When a beneficiary receiving a DMEPOS item from another payer (including a Medicare Advantage plan) becomes eligible for the Medicare Fee for Service (FFS) program, the first Medicare claim for that item or service is considered a new initial Medicare claim. Medicare does not automatically continue coverage for any item obtained from another payer when a beneficiary transitions to Medicare coverage.
For Medicare to provide payment, the beneficiary must meet all Medicare coverage, coding, and documentation requirements for the DMEPOS items in effect on the DOS of the initial Medicare claim. Refer to the applicable Local Coverage Determination (LCD) and policy article for the item. This information must be available upon request.
A POD is required for all items, even those in the beneficiary’s possession provided by another insurer prior to Medicare eligibility.
- Proof of delivery requirements for recently eligible Medicare FFS, the supplier record must document:
- A statement, signed and dated by the beneficiary (or beneficiary's designee), that the supplier has examined the item, meets the POD requirements; and
- A supplier attestation that the item meets Medicare requirements.
For the purposes of reasonable useful lifetime and calculation of continuous use, the first day of the first rental month in which Medicare payments are made for the item (i.e., DOS) serves as the start date of the reasonable useful lifetime and period of continuous use. In these cases, the POD documentation serves as evidence that the beneficiary is already in possession of the item.
Billing rental of a device, a replacement device and/or supplies/accessories for beneficiary-owned item
- Rentals - DMEPOS Payment Categories requirements for specific rental item
- Replacement Refers to the provision of an identical or nearly identical item
- Supplies and/or accessories - Beneficiary-owned item
Last Updated Fri, 23 Sep 2022 17:11:45 +0000