From time to time, we get questions from our customers about durable medical equipment and Medicare. Earlier this year, we published an article about what durable medical equipment (DME) Medicare covers and briefly discussed the competitive bidding process that took effect in 2011, and expanded this year. While that article covers much of what you may need to know, we know many of you may have other questions about this ever-changing area of healthcare. While any formal questions related to Medicare should be directed to Medicare.gov, we’ve researched and compiled answers to other questions you may have.
Q: How do I replace lost or damaged durable medical equipment or supplies in a disaster or emergency?
I have Original Medicare
If Original Medicare already paid for durable medical equipment (DME) (like a wheelchair or walker) or supplies (like diabetic supplies) damaged or lost due to an emergency or disaster:
- In certain cases, Medicare will cover the cost to repair or replace your equipment or supplies
- Generally, Medicare will also cover the cost of rentals for items (such as wheelchairs) during the time your equipment is being repaired
I have a Medicare Advantage Plan or other Medicare health plan
Contact your plan directly to find out how it replaces DME or supplies damaged or lost in an emergency or disaster. Get your plan’s contact information.
Q: What areas of California are presently included in the Competitive Bidding Program?
According to Medicare.gov, the following areas in California are affected by Medicare’s Competitive Bidding Program as of July 2013:
- Bakersfield-Delano, CA
- Fresno, CA
- Los Angeles-Long Beach-Santa Ana, CA
- Oxnard-Thousand Oaks-Ventura, CA
- Sacramento–Arden-Arcade–Roseville, CA
- San Diego-Carlsbad-San Marcos, CA
- San Francisco-Oakland-Fremont, CA
- San Jose-Sunnyvale-Santa Clara, CA
- Stockton, CA
- Visalia-Porterville, CA
Q: How do I file a complaint about my durable medical equipment?
With your supplier or with Medicare:
You may file a complaint with your supplier, or call 1-800-MEDICARE.
Within 5 calendar days, the supplier must let you know they got your complaint and are investigating it.
Within 14 days, the supplier must send you the result and their response in writing.
With the Competitive Acquisition Ombudsman
Your complaint may also be referred to the Competitive Acquisition Ombudsman. The Ombudsman responds to individual and supplier inquiries, issues, and complaints. The Ombudsman reviews the concerns raised by people with Medicare through 1-800-MEDICARE and through your State Health Insurance Assistance Program (SHIP).
Q: Someone told me my DME Supplier needs to be accredited to be covered by Medicare. Is that true?
In November 2006, the Centers for Medicare & Medicaid Services (CMS) approved 10 national accreditation organizations that will accredit suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) as meeting new quality standards under Medicare Part B.
In order to enroll or maintain Medicare billing privileges, all DMEPOS suppliers (except for exempted professionals and other persons as specified by the Medicare Improvement for Patients and Providers Act of 2008) must comply with the Medicare program’s supplier standards (found at 42 CFR §424.57 (c)) and quality standards to become accredited. The accreditation requirement applies to suppliers of durable medical equipment, medical supplies, home dialysis supplies and equipment, therapeutic shoes, parenteral/enteral nutrition, transfusion medicine and prosthetic devices, and prosthetics and orthotics.
On March 23, 2010, the President signed HR 3590 into Public Law no: 111-148, which amends title XVII of the Social Security Act to exempt a pharmacy from accreditation if it meets all of the following criteria.
- the total billings by the pharmacy for DMEPOS are less than 5 percent of total pharmacy sales;
- the pharmacy has been enrolled as a supplier of durable medical equipment, prosthetics, orthotics and suppliers, as has been issued a provider number for at least 5 years;
- no final adverse action has been imposed on the pharmacy in the past 5 years;
- the pharmacy submits an attestation, as determined by CMS, that the pharmacy meets the first three criteria;
- the pharmacy agrees to submit materials as requested during the course of an audit conducted on a random sample of pharmacies selected annually.