Medicare Claims Processing Manual (Pub. 100-04), Ch. 30 § 50.15.4

Supplier’s Right to Recover Resalable Items for Which Refund

Last amended: 2021Year: 2021Length: 295 wordsOfficial source
50.15.4 - Supplier’s Right to Recover Resalable Items for Which Refund Has Been Made (Rev. 10862; Issued: 07-14-21; Effective: 10-14-21; Implementation: 10-14-21) If the Medicare contractor denies Part B payment for an item of medical equipment or supplies on the basis of §1862(a)(1), §1834(a)(17)(B), §1834(j)(1), or §1834(a)(15) of the Act, and the beneficiary is relieved of liability for payment for that item under §1834(a)(18) of the Act, the effect of the denial, subject to State law, cancels the contract for the sale or rental of the item. If the item is resalable or re-rentable, the supplier is permitted to repossess the item. Suppliers are strongly discouraged from recovering items which are consumable or not fit for resale or re-rental. If a supplier makes proper refund under §1834(a)(18) of the Act, Medicare rules do not prohibit the supplier from recovering from the beneficiary items which are resalable or re-rentable. When the contract of sale or rental is cancelled on the basis described above, the supplier may enter into a new sale or rental transaction with the beneficiary as long as the beneficiary has been informed of their liability. If the circumstances which preclude payment for the item have been removed (e.g. the supplier has now obtained a supplier number when that supplier did not have one before), the supplier may submit to the Medicare contractor a new claim based on the resale or re-rental of the item to the beneficiary. If payment is still precluded, the supplier can issue an ABN. Under the capped-rental method, if the Medicare contractor determines that the supplier is obligated to make a refund, the supplier must repay Medicare those rental payments that the supplier has received for the item. However, the Medicare beneficiary must return the item to the supplier.
Medicare Claims Processing Manual (Pub. 100-04), Ch. 30 § 50.15.4: Supplier’s Right to Recover Resalable Items for Which Refund | Justis AI