Safeguards in Making Monthly Payments

5.13 - Safeguards in Making Monthly Payments (Rev. 10749; Issued: 05-11-21; Effective: 06-11-21; Implementation: 06-11-21) The DME MACs and UPICs shall establish appropriate safeguards to assure that payments are not made beyond the last month of medical necessity. They must develop appropriate safeguards to identify and investigate the following: • Multiple claims for rental of the same or similar equipment from the same supplier within the same rental month (e.g., rental claims with different start dates but within the same rental period); Pub. 100-04, chapter 20, §30.5 specifically forbids payments for multiple claims for rental of the same or similar equipment from either the same or a different supplier during the same rental month. • Contraindicated items of rented or purchased equipment; • Incompatible claims information (e.g., liquid oxygen contents billed for a purchased gas delivery system); • Medical equipment rentals or purchases after a beneficiary's death; • Rental start dates on or after the purchase of the same or comparable equipment (absent evidence that the beneficiary has disposed of purchased equipment); • Rental claims for the same or similar equipment from different suppliers for the same or overlapping rental months; and • Equipment rental start dates within periods of confinement in an institution that cannot be considered a patient's home. The DME MACs and UPICs shall resolve these situations on a prepayment basis. Development, if necessary, may be via written or telephone contact per Pub. 100-08 subject to any other documentation or development guidelines specified in Pub. 100-02, chapter 15, §100-01, Pub. 100-04, chapter 20, §10.1.1 and Pub. 100-04, chapter 20, §100.2.3. To the extent possible, DME MACs and UPICs give beneficiaries and supplier- assignees advance notice of the date and reason that payments are scheduled to stop. (See Pub. 100- 04, chapter 21 for EOMB language.)