0046 - Durable Medical Equipment Rentals- Multiple Billing within the Same Month

Description

Overpayments associated to DMEPOS suppliers billing multiple rentals for the same equipment within the same month (27 days) will be recovered.

Affected Code(s)

A4639, A7025, E0117, E0140, E0144, E0149, E0165, E0170, E0171, E0181, E0182, E0186, E0187, E0193, E0194, E0196, E0197, E0198, E0202, E0235, E0236, E0250, E0251, E0255, E0256, E0260, E0261, E0265, E0266, E0277, E0290, E0291, E0292, E0293, E0294, E0295, E0296, E0297, E0300, E0301, E0302, E0303, E0304, E0305, E0316, E0371, E0372, E0373, E0424, E0431, E0433, E0434, E0439, E0462, E0470, E0471, E0472, E0480, E0482, E0483, E0500, E0550, E0565, E0570, E0572, E0574, E0575, E0585, E0600, E0601, E0606, E0617, E0618, E0619, E0620, E0630, E0635, E0636, E0639, E0640, E0656, E0657, E0675, E0740, E0744, E0745, E0749, E0762, E0764, E0776, E0779, E0781, E0784, E0791, E0849, E0855, E0856, E0910, E0911, E0912, E0920, E0930, E0940, E0941, E0946, E0955, E0958, E0968, E0983, E0988, E1002, E1003, E1004, E1005, E1006, E1007, E1008, E1010, E1012, E1014, E1020, E1028, E1029, E1030, E1031, E1035, E1036, E1037, E1038, E1039, E1050, E1060, E1070, E1083, E1084, E1087, E1088, E1092, E1093, E1100, E1110, E1150, E1160, E1161, E1170, E1171, E1172, E1180, E1190, E1195, E1200, E1221, E1222, E1223, E1224, E1225, E1228, E1232, E1233, E1234, E1235, E1236, E1237, E1240, E1270, E1280, E1295, E1390, E1391, E1392, E1405, E1406, E1700, E1800, E1801, E1802, E1805, E1806, E1811, E1812, E1815, E1816, E1818, E1840, E1841, E2000, E2120, E2310, E2311, E2312, E2313, E2321, E2322, E2325, E2326, E2327, E2328, E2329, E2330, E2368,  E2369, E2370, E2373, E2374, E2375, E2376, E2377, E2378, E2402, K0001, K0002, K0003, K0004, K0006, K0007, K0009, K0010, K0011, K0012, K0195, K0455, K0606, K0730, K0738, K0813, K0814, K0815, K0816, K0820, K0821, K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0835, K0836, K0837, K0838, K0839, K0840, K0841, K0842, K0843, K0848, K0849, K0850, K0851, K0852, K0853, K0854, K0855, K0856, K0857, K0858, K0859, K0860, K0861, K0862, K0863, K0864, K1002,  K1016, K1018, K1020, K1024, K1025, K1031, K1032, K1033, B9002, B9004, B9006

Applicable Policy References

1.    Social Security Act (SSA), Title XVIII- Health Insurance for the Aged and Disabled, §1833(e) - Payment of Benefits
2.    Social Security Act (SSA), Title XVIII- Health Insurance for the Aged and Disabled, §1834(a)(7)(C)(i), (ii) and (iii)- Replacement of Items
3.    Social Security Act (SSA), Title XVIII- Health Insurance for the Aged and Disabled, §1842(p)(4)- Provisions Relating to the Administration of Part B
4.    Social Security Act (SSA), Title XVIII- Health Insurance for the Aged and Disabled, §1862(a)(1)(A)- Exclusions from Coverage and Medicare as a Secondary Payer
5.    42 Code of Federal Regulations (CFR), §405.980- Reopening of Initial Determinations, Redeterminations, Reconsiderations, Decisions, and Reviews, (b)- Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Initiated by a Contractor; and (c)- Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Requested by a Party
6.    42 CFR § 405.929- Post-Payment Review
7.    42 CFR § 405.930- Failure to Respond to Additional Documentation Request
8.    42 CFR §405.986- Good Cause for Reopening
9.    42 CFR, §410.38- Durable medical equipment, prosthetics, orthotics and supplies (DMEPOS): Scope and conditions
10.    42 CFR, §414.210(f)- Payment for Replacement of Equipment
11.    National Coverage Determination Manual, Chapter 1, Part 4, §280.1- Durable Medical Equipment Reference List
12.    Medicare Claims Processing Manual, Ch. 20- Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) §50- Payment for Replacement of Equipment; §110- General Billing Requirements - for DME, Prosthetics, Orthotic Devices, and Supplies
13.    Medicare Benefit Policy Manual, Ch. 16- General Exclusions from Coverage, §180- Services Related to and Required as a Result of Services Which Are Not Covered Under Medicare
14.    Medicare Program Integrity Manual, Ch. 3- Verifying Potential Errors and Taking Corrective Actions, §3.2.3.8- No Response or Insufficient Response to Additional Documentation Requests; §3.3- Policies and Guidelines Applied During Review; §3.3.1.3- Automated Review
15.    Durable Medical Equipment, Prosthetics, Orthotics and Supplies Fee Schedule
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/DMEPOSFeeSched/DMEPOS-Fee-Schedule
16.     HCPCS Level II Codebook