Page 130 - Medicare Benefit Policy Manual

conjunction with DME for resale to the beneficiary. Reimbursement may be made for
replacement of essential accessories such as hoses, tubes, mouthpieces, etc., for necessary
DME, only if the beneficiary owns or is purchasing the equipment.

110.4 - Miscellaneous Issues Included in the Coverage of Equipment
(Rev. 1, 10-01-03)
B3-2100.6, A3-3113.5, HO-235.5, HHA-220.6

Payment can be made for the purchase of DME even though rental payments may have
been made for prior months. This could occur where, because of a change in his/her
condition, the beneficiary feels that it would be to his/her advantage to purchase the
equipment rather than to continue to rent it.

A beneficiary may sell or otherwise dispose of equipment for which they have no further
use, for example, because of recovery from the illness or injury that gave rise to the need
for the equipment. (There is no authority for the program to repossess the equipment.) If
after such disposal there is again medical need for similar equipment, payment can be
made for the rental or purchase of that equipment.

However, where an arrangement is motivated solely by a desire to create artificial
expenses to be met by the program and to realize a profit thereby, such expenses would
not be covered under the program. The resolution of questions involving the disposition
and subsequent acquisition of durable medical equipment must be made on a case-by-
case basis.

Cases where it appears that there has been an attempt to create an artificial expense and
realize a profit thereby should be developed and when appropriate denied. After
adjudication the DME MAC would refer such cases to the program integrity specialist in
the RO.

When payments stop because the beneficiary’s condition has changed and the equipment
is no longer medically necessary, the beneficiary is responsible for the remaining
noncovered charges. Similarly, when payments stop because the beneficiary dies, the
beneficiary’s estate is responsible for the remaining noncovered charges.

Contractors do not get involved in issues relating to ownership or title of property.

110.5 - Incurred Expense Dates for Durable Medical Equipment
(Rev. 1, 10-01-03)
A3-3113.7.B, HO-235.7.B, B3-3011

The date of service on the claim must be the date that the beneficiary or authorized
representative received the DMEPOS item. If the date of delivery is not specified on the
bill, the contractor should assume, in the absence of evidence to the contrary, that the date
of purchase was the date of delivery.