As a supply item, Medicare and many other payers have defined refill requirements that must be followed when providing the items on an as-needed basis. Most of these requirements follow the same structured requirements:
- Continued medical need
- Request for refill for shipped supplies
- Proof of delivery
These requirements typically apply to patients who are established with their respective DMEPOS or O&P supplier, meaning the supplier previously provided the items that need to be refilled and/or the prosthesis for which the items are needed. If the patient is new to the supplier and requests a refill of supplies, it is in the supplier’s best interest to obtain compliant documentation, including basic coverage criteria supported by the treating practitioner’s (physician) medical records, as there isn’t a guarantee that the previous supplier obtained compliant documentation when the device was provided.
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