CMS eases requirements for changing providers

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Monday, April 3, 2017

WASHINGTON – CMS has instructed the DME MACs to accept timely orders and medical documentation whether they come from a beneficiary’s treating physician or a transferring HME provider.

The change is a big deal for providers in competitive bidding areas, where transfers of beneficiaries from non-contract to contract providers are common.

“Industry (has) suggested that competition is bolstered and provider burden limited by allowing suppliers to accept medical documentation from other suppliers who previously held responsibility for that beneficiary,” CMS states in Change Request 9886 published on March 24.

The change goes into effect April 24, 2017.

Specifically, CMS instructs the DME MACs to:

  • Accept documentation of the beneficiary’s need for an item, regardless of whether the supplier received the documentation directly from the beneficiary’s treating physician/practitioner or as transferred from his or her previous supplier.
  • Contractors shall, in those instances in which the documentation is not transferred, continue to require a new order/documentation be received by the supplier from the treating physician/practitioner.
  • Contractors shall describe any necessary workload changes in detail, including the rationale for these changes, to their Contracting Officer’s Representative and Medical Review Business Function Lead.

In an accompanying MLN Matters article, CMS put providers on notice that a new order is still required in the following situations:

  • There is a change in the order for the accessory, supply, drug and so forth.
  • On a regular basis (even if there is no change in the order) only if it is so specified in the documentation section of a particular medical policy.
  • When an item is replaced.
  • When there is a change in the supplier, if the recipient supplier did not obtain a valid order for the DMEPOS item from the transferring supplier.