Noridian Administrative Services revised rules for durable medical equipment items, including CPAP, that are provided on a recurring basis.
Effective for dates of service on or after August 2, 2011, suppliers are required to have contact with the beneficiary or caregiver/designee prior to dispensing a new supply of items.
According to Noridian, “For all DMEPOS items and supplies provided on a recurring basis, billing must be based on prospective, not retrospective use. For DMEPOS products that are supplied as refills to the original order, suppliers must contact the beneficiary prior to dispensing the refill and not automatically ship on a predetermined basis, even if authorized by the beneficiary.”
The policy is designed to make sure that the refilled items remain reasonable and necessary, and that existing supplies are approaching exhaustion, and to confirm any changes/modifications to the order. According to Noridian, “Suppliers must not dispense a quantity of supplies exceeding a beneficiary’s expected utilization. Suppliers must stay attuned to changed or atypical utilization patterns on the part of their clients. Suppliers must verify with the ordering physicians that any changed or atypical utilization is warranted. Regardless of utilization, a supplier must not dispense more than a 1- or 3-month quantity at a time.”
For nonconsumable supplies like PAP, the supplier should assess whether the supplies remain functional, providing replacement (a refill) only when the supply item(s) is no longer able to function. The supplier must document the functional condition of the item(s) being refilled in sufficient detail to demonstrate the cause of the dysfunction that necessitates replacement (refill).
Further details can be found in the announcement.
