I hear that Medicare will soon begin denying claims for DMEPOS items and services that are referred by physicians and treating practitioners who are not enrolled with Medicare in PECOS. Are competitive bidding contract suppliers required to furnish DMEPOS items and services in their contracts to any Medicare beneficiary residing in a competitive bidding area, regardless of whether the prescribing physician or eligible treating professional is enrolled with Medicare?
Medicare has issued regulations implementing new requirements for DMEPOS suppliers, including DMEPOS contract suppliers (see the interim final rule with comment period (IFC) titled Medicare and Medicaid Programs; Changes in Provider and Supplier Enrollment, Ordering and Referring, and Documentation Requirements; and Changes in Provider Agreements published on May 5, 2010; 75 FR 24437).
The requirements for physicians and treating practitioners to be enrolled in Medicare as a condition for Medicare claims payment, as set forth in that regulation, are consistent with contract suppliers’ responsibilities under the Competitive Bidding Program. Contract suppliers are expected to follow the requirements set forth in the May 5, 2010, IFC because covered items under the Competitive Bidding Program generally include only those DMEPOS items for which payment would otherwise be made under Medicare’s DMEPOS fee schedules outside the Competitive Bidding Program.
When Medicare begins to implement this new requirement, competitively bid and non-competitively bid items and services ordered by a physician or other treating practitioner who is not enrolled in Medicare will not be paid, as stipulated by the Affordable Care Act (ACA 2010). Therefore, contract suppliers would not be required to furnish items to beneficiaries whose ordering physician or treating practitioner is not enrolled with Medicare in PECOS.