Documentation Requirements for DMEPOS Supplied as Refills

5.2.6 - Documentation Requirements for DMEPOS Supplied as Refills to the Original Order (Rev. 12512; Issued: 02-15-24; Effective: 01-01-24; Implementation: 02-19-24) Per 42 CFR 410.38 related to DMEPOS products that are supplied as refills to the original order/prescription, suppliers must contact the beneficiary prior to dispensing the refill and not automatically ship on a pre-determined basis, even if authorized by the beneficiary. This shall be done to ensure that the refilled item remains reasonable and necessary and to confirm any changes/modifications to the SWO. The DMEPOS supplier must document contact with the beneficiary or their representative to verify the refill is needed. This documentation must include the following: • Evidence of the beneficiary or their representative’s affirmative response of the need for supplies, which should be obtained as close to the expected end of the current supply as possible. However, such contact and affirmative response must be within 30 calendar days from the expected end of the current supply. o For shipped items: the beneficiary’s name, date of contact, the item requested, and an affirmative response from the beneficiary, indicative of the need for refill, prior to dispensing the product is required. Beneficiary’s need not count the remaining supply. o For items obtained in-person from a retail store, the delivery slip signed by the beneficiary or their representative or a copy of the itemized sales receipt is sufficient documentation of a request for refill. Suppliers are permitted to use any mode of communication so long as the beneficiary affirmation is received, and documentation of the contact is captured and can be provided upon request. • For example, automated text messaging or email may be used so long as the captured information demonstrates the beneficiary’s name, item(s), date of contact, and affirmative response. For delivery of refills, the supplier must deliver the DMEPOS product no sooner than 10 calendar days prior to the end of usage for the current product. This is regardless of which delivery method is utilized. DME MACs shall allow for the processing of claims for refills delivered/shipped prior to the beneficiary exhausting his/her supply.