PAMS: CBA Reimbursement Question Clarification from CBIC

PAMS has received a positive response from CMS and the Competitive Bidding Implementation Contractor (CBIC) regarding who can serve Medicare beneficiaries who live outside of a CBA but who purchase their equipment and supplies from within a CBA.

According to CBIC Chief Liaison Elaine Hensley, CMS has reversed a prior opinion that stated that such patients could only receive equipment and supplies from a contracted provider. The NEW interpretation applies the same standard as is used for a non-CBA beneficiary who is hospitalized in a CBA. Since the beneficiary will be predominately using the DME in item in his/her home, which is outside of a CBA, s/he may obtain DME from any enrolled supplier, regardless of whether they deliver the DME or the beneficiary travels to a CBA to pick up the DME.

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