Discussion Forum

Editor’s Note:  CMS’ Medicare Learning Network (MLN) Matters Number 8080 is attached here.  The document’s Key Points are printed below:

•  Beneficiaries may choose to pick up diabetic testing supplies in person from retail pharmacy locations or other local supplier storefronts or have them delivered to their homes. Once the program is implemented, only NMO contract suppliers will be reimbursed by Medicare Part B for providing diabetic testing supplies delivered to beneficiaries’ residences. If the supplies are shipped or delivered by any means to the beneficiary’s home, then the supplier that furnished the supplies must be a NMO contract supplier for Medicare to pay.

•  The only diabetic testing supplies not included in the program are those that are obtained directly by a beneficiary or caregiver by physically going to an enrolled DMEPOS supplier storefront and leaving the store with the diabetic testing supplies.

•  The only supplier that can bill for these non mail-order diabetic supplies is the supplier from which the beneficiary or caregiver physically picked up the supplies. Diabetic supplies furnished by any means other than mail-order or pickup are not payable by Medicare.

•  The term “mail-order” means items shipped or delivered to the beneficiary’s residence by any method.

•  All suppliers are required to use the KL modifier on each claim for diabetic supplies furnished on a mail-order basis. Suppliers that furnish diabetic testing supplies on a mail-order basis that do not attach the mail-order modifier could be subject to significant penalties.

•  Claim lines for items subject to the NMO program for diabetic supplies provided by a non- contract supplier on or after July 1, 2013 will be denied, For paid claim lines where the submitted charge exceeds the single payment amount in the contract, the remittance will be the single payment amount. Contract suppliers must accept assignment for items in their contracts.