Medicare Claims Processing Manual (Pub. 100-04), Ch. 36 § 20.6.1.1.3
Notification to Beneficiaries by Suppliers that Choose to Become
20.6.1.1.3 - Notification to Beneficiaries by Suppliers that Choose to Become
Grandfathered Suppliers
(Rev. 1532, Issued: 06-11-08, Effective: 07-01-08, Implementation: 07-07-08)
A noncontract supplier that elects to become a grandfathered supplier is responsible for
providing notification to its Medicare customers residing in CBAs who are furnished items
identified in section 20.6.1. This notification should meet the following guidelines:
NOTE: This notification should only be sent to beneficiaries who the supplier is currently
serving and who maintain a permanent residence in a CBA. The list of ZIP Codes for each CBA,
the list of the HCPCS for competitively bid items, and the single payment amounts for these
items are located in public use files on the CBIC Web site at:
http://www.dmecompetitivebid.com/palmetto/cbic.nsf/DocsCat/Home.
• It should state that the supplier is offering to continue to furnish rental DME, oxygen and
oxygen equipment and/or related accessories and supplies that it is currently furnishing to
the beneficiary (i.e., before the start of the competitive bidding program) and to provide
these items to the beneficiary for the remainder of the rental period.
• It should state that the beneficiary has the choice to continue to receive a grandfathered
item(s) from the grandfathered supplier or to elect to begin receiving the item(s) from a
contract supplier after the competitive bidding program begins.
• It should provide the supplier’s telephone number so the beneficiary or caregiver may
call and notify the supplier of his/her election.
• The supplier should provide notification to the beneficiary at least 30 days before the start
date of the implementation of the Medicare DMEPOS Competitive Bidding Program.
• The supplier should receive an election from a beneficiary and maintain a record as to
whether the beneficiary chose to continue to receive the item from a grandfathered
supplier, chose to go to a contract supplier to receive the item or did not respond. The
record should indicate, at a minimum, the date that the beneficiary is notified that the
supplier elected to become a grandfathered supplier for the item(s), the date the
beneficiary made an election (if applicable), and the methods of communication used in
the case of each election activity (e.g. letter to the beneficiary).
• The supplier should inform the beneficiary of the end date of service and that
arrangements will be made to pick-up the item within 10 days of picking up the item.
• The supplier should remind the beneficiary of the date and time the equipment will be
picked up within 2 business days of picking up the equipment.
Recommended Schedule for Suppliers to Notify Beneficiaries of the Necessity to Decide on
Arrangements for Choosing to Use a Grandfathered Supplier or Contract Supplier
Notification - Supplier
Number of Days Before the Start Date of the
Competitive Bidding Program
Initial Notification in writing
30 days
Notification before picking up
equipment
Within 10 days before picking up the equipment.
Final Notification before picking up
equipment
Within 2 business days of picking up the
equipment
** A sample notification letter will be posted on the CBIC Web site at
www.dmecompetitivebid.com.