Program_Memos / 2001 / B-01-68

Why This Topic Matters

It clarifies a Medicare policy change affecting how upgraded DMEPOS items are represented on claims and how related beneficiary liability is handled. This makes it important for organizations that submit, process, or audit DMEPOS claims.

Article Sections

1. Background

   Introduces the Medicare policy context for upgraded DMEPOS items and discusses beneficiary liability and supplier practices.

2. Policy

   Summarizes the general policy position on furnishing upgraded DMEPOS items without adding extra cost to the program or beneficiary.

3. Billing Instructions for January 1, 2002

   Describes the initial billing approach and claim reporting changes tied to the first implementation date.

4. Billing Instructions for April 1, 2002

   Describes the updated billing approach and claim reporting requirements taking effect with the later implementation date.

5. Medicare Summary Notice (MSN) and Remittance Advice (RA)

   Identifies the notice and remittance messaging associated with claims processed under this policy.

6. Separate Instructions for when there is an Extra Charge for an Upgrade

   Notes that additional guidance will address situations where a beneficiary is responsible for an upgrade-related difference in cost.