Providers Still Have Questions on NCB
This rule applies to all competitively bid items except for mail order diabetic supplies.
If a beneficiary residing in a non-CBA is within the 13-month rental period for CPAP equipment and they travel to a CBA (snowbird), is the beneficiary required to return the CPAP machine to the home supplier in the non-CBA and rent the CPAP equipment from a contract supplier in the CBA or can the home supplier continue to bill for rental of the CPAP?
The home supplier that provided the CPAP to the beneficiary may continue to rent the CPAP equipment and submit claims for the remainder of the rental period. However, supplies and accessories must be obtained from a contract supplier within the competitive bidding area to which the beneficiary travels.
Please explain the rules for mail-order diabetic supplies for both traveling beneficiaries that reside in a CBA and for traveling beneficiaries that do not reside in a CBA.
If a beneficiary's permanent residence is in a competitive bidding area, the beneficiary must get the mail-order diabetic supplies from a contract supplier. If they are traveling, even if they travel to a noncompetitive bidding area, they must still obtain mail order diabetic supplies from a contract supplier since the item is furnished by mail. So as long as the beneficiary's permanent address or permanent residence is in a competitive bidding area, then the mail order diabetic supplies, regardless of where the beneficiary is, must be provided by a contract supplier.
However, because diabetic supplies purchased from a storefront are not subject to competitive bidding, the beneficiary may purchase diabetic supplies from any Medicare supplier that furnishes these items. If the beneficiary does not reside in a competitive bidding area, the beneficiary may obtain their mail-order supplies from any Medicare supplier.
If the beneficiary's permanent residence is in a noncompetitive bidding area, and he/she travels into a competitive bidding area, the noncontract supplier from that noncompetitive bidding area (the beneficiary's place of residence) may continue to furnish the mail order diabetic supplies. So, a beneficiary that resides in a noncompetitive bidding area and travels to a competitive bidding area, does not have to obtain their mail order diabetics supplies in a competitive bidding area from a contract supplier. That is an exception to general competitive bidding rules for beneficiaries who travel or temporary relocate.