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The Times of Our Lives

Being a supplier of Medicare Durable Medical Equipment entails a long list of ever changing deadlines and timeframes.  While it may seem difficult to keep track of them all, failure to keep abreast can easily result in claims denials and even exclusion from the program.  In order to help suppliers keep fitting and getting paid, the following are dates and timeframes that all should be familiar with.

  • January 1: Every patient eligible for new shoes if documented need for replacement
  • 3 months: Time allowed from when certifying physician signs certifying statement to when shoes must be fit.
  • 3 months: ADA recommended frequency for comprehensive diabetic foot exam for patients of foot risk category 3 (history of ulceration, amputation)
  • 6 months: Amount of time condition requiring stabilization could justify utilization of custom made AFO.
  • 6 months:  Time prior to fitting shoes that patient needs to have been seen by the physician managing their diabetes
  • 6 months: ADA recommended frequency for comprehensive diabetic foot exam for patients of foot risk category 2 (neuropathy present)
  • 1 year: Interval when Medicare DME supplier number will become inactivated if no DME if billed to Medicare. Reactivation required resubmission of supplier application.
  • 1 year: ADA recommended frequency for comprehensive diabetic foot exam for patients of foot risk category 0 (No neuropathy, protective sensation intact)
  • 3 years: Interval when Medicare DME suppliers must have supplier information revalidated. Registration every three years requires payment of $505 payment and may entail visit from inspector.
  • 3 -5 years: Amount of time custom made durable medical equipment is expected to last unless there is change in patient’s condition such that there is justified new reason of “medical necessity”
  • 2030: Time by which Medicare population is expected to double versus 2000 levels*

*MedPAC Report to Congress: Promoting Greater Efficiency in Medicare, June 2007. Washington DC: Medicare Payment Advisory Commission, June 2007.