Beneficiaries Entering Medicare

Equipment Retained from a Prior Payer

When a beneficiary receiving a DMEPOS item from another payer becomes eligible for the Medicare Fee-for-Service (FFS) program or switches from a Medicare Advantage plan to the Medicare 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 FFS coverage.

For Medicare FFS to provide payment, the beneficiary must meet all Medicare coverage, coding, and documentation requirements for the DMEPOS items in effect on the date of service (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 proof of delivery (POD) is required for all items, even those in the beneficiary's possession provided by another insurer prior to Medicare eligibility.

  • To meet POD requirements for beneficiaries recently eligible for 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, including reasonable useful lifetime (RUL) 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 RUL and period of continuous use. In these cases, the POD documentation serves as evidence that the beneficiary is already in possession of the item.

Requirements for billing items or equipment to FFS Medicare that were obtained from a prior payer before becoming FFS Medicare eligible:

Last Updated Sep 17 , 2024