Procedures for Requesting Dme Medical Supplies and Equipment

(REVISED) PROCEDURES FOR REQUESTING DURABLE MEDICAL EQUIPMENT, PROSTHETICS, ORTHOTICS, AND SUPPLIES (DMEPOS) VIA MEDICARE PART B AND DUAL ELIGIBLE/DUAL ELIGIBLE (QMB) 1 DMEPOS MEDICARE PART B OR DUAL ELIGIBLE/DUAL ELIGIBLE (QMB) BENEFICIARIES B E N E F I C I A R I E S W H O A R E C L A SS I F I E D A S M E D I C A R E PA R T B O R D U A L ELIGIBLE/DUAL ELIGIBLE (QMB) MUST H AV E T H E I R P R I O R A U T H O R I Z AT I O N REQUEST(S) FOR DMEPOS SUPPLIES/ EQUIPMENT SUBMITTED TO

M E D I C A R E F I R S T, A S M E D I C A R E PA R T B IS THE FIRST INSURER AND FOR D U A L S - - PA R T B I S T H E F I R S T INSURER ALSO, WITH DC MEDICAID BEING THE SECOND INSURER FOR DUALS. 2 DMEPOS MEDICARE PART B OR DUAL ELIGIBLE/DUAL ELIGIBLE (QMB) BENEFICIARIES BEFORE PROCEEDING WITH THE INSTRUCTIONS ON THE F O L L O W I N G PA G E S , P L E A S E V E R I F Y T H E B E N E F I C I A RY S

INSURANCE ELIGIBILITY/COVERAGE VIA DC M E D I C A I D W E B P O RTA L O R V I A INTERACTIVE VOICE RESPONSE ( I V R ) AT 2 0 2 - 9 0 6 - 8 3 1 9 . 3 DMEPOS MEDICARE PART B OR DUAL ELIGIBLE/DUAL ELIGIBLE (QMB) BENEFICIARIES FOR ALL DMEPOS S U P P L I E S / E Q U I P M E N T, T H E B E N E F I C I A RY M U S T O B TA I N A PRESCRIPTION (NOT A 719A F O R M ) F R O M T H E I R AT T E N D I N G

PHYSICIAN WITH MEDICAL J U S T I F I C AT I O N ; A N D I N S O M E I N S TA N C E S M E D I C A L C H A RT NOTES. FOR SOME E Q U I P M E N T / S U P P L I E S , A FA C E T O - FA C E W I T H T H E P C P M AY B E 4 DMEPOS MEDICARE PART B OR DUAL ELIGIBLE/DUAL ELIGIBLE (QMB) BENEFICIARIES T H E B E N E F I C I A RY G I V E S T H E PRESCRIPTION, MEDICAL J U S T I F I C AT I O N A N D M E D I C A L C H A RT N O T E S ( I F R E Q U I R E D ) T O A C E RT I F I E D M E D I C A R E D M E P O S

SUPPLIER OF THEIR CHOICE. N O T E : A S A P R OV I D E R , YO U S H O U L D A LWAY S G I V E T H E B E N E F I C I A RY T H E C H O I C E O F T H R E E ( 3 ) C E RT I F I E D M E D I C A R E SUPPLIERS TO SELECT FROM. 5 DMEPOS MEDICARE PART B OR DUAL ELIGIBLE/DUAL ELIGIBLE (QMB) BENEFICIARIES T H E B E N E F I C I A RY S H O U L D A LW AY S C H E C K W I T H T H E C E RT I F I E D M E D I C A R E D M E P O S S U P P L I E R ( S ) T O M A K E C E RTA I N T H AT T H E Y A R E S T I L L C E RT I F I E D

WITH MEDICARE TO PROVIDE DMEPOS SUPPLIES OR EQUIPMENT NEEDED. 6 DMEPOS MEDICARE PART B OR DUAL ELIGIBLE/DUAL ELIGIBLE (QMB) BENEFICIARIES T E R M I N AT I O N O F M E D I C A R E S C O M P E T I T I V E B I D D I N G PROGRAM P L E A S E B E A D V I S E D T H AT A S O F D E C E M B E R 31, 2018, THE DMEPOS COMPETIVE BIDDING PROGRAM CONTRACTS EXPIRED AND WILL R E M A I N S O U N T I L A P P R O X I M A T E LY D E C E M B E R 31, 2020.

EF FEC T I V E , J A N UA RY 1 , 2 0 1 9 A N Y C E RT I FI E D D M E P O S S U P P L I E R M AY F U R N I S H D M E P O S S U P P L I E S O R E Q U I P M E N T. ( S E E A T T A C H E D D E TA I L E D I N F O R M AT I O N O N T H I S N E W PROCEDURE AND A LIST OF MEDICARES CERTIFIED SUPPLIERS) NOTE: INCONTINENCE SUPPLIES AND A U T O M AT I C B L O O D P R E SS U R E M O N I T O R S D O NOT NEED A DENIAL FROM MEDICARE ALL 7 CERTIFIED MEDICARE DMEPOS SUPPLIERS CAN DMEPOS MEDICARE PART B OR DUAL ELIGIBLE/DUAL ELIGIBLE (QMB) BENEFICIARIES RESOURCE NOTES Y O U C A N A L S O LO C AT E A M E D I C A R E C E RT I F I E D

D M E P O S S U P P L I E R BY: U S I N G TH E M ED I C A R E S U P P L I ER D I R EC T O RY ( W W W / M E D I C A R E . G OV / S U P P L I E R ) O R BY CALLING 1-800-MEDICARE (1-800-633-4227) TO A S K A Q U E S T I O N O R F I L E A C O M P L A I N T. O N T U E S D AY S A N D W E D N E S D AY S , Y O U C A N C O N TA C T M E F O R A SS I S TA N C E AT T H E O F F I C E O F H E A LT H C A R E O M B U D S M A N A N D B I L L O F R I G H T S (OHCOBR) 202-724-4207 (DIRECT LINE) 202-724-7491 (GENERAL LINE) 8