Telephone Solicitation of Medicare Beneficiaries

Applicability:

O&P’s, DME Companies, Physician Offices

The Issue:

Medicare has carefully defined how and when DMEPOS suppliers can contact beneficiaries. If you fail to comply with these requirements, you could find yourself the subject of an investigation and place your Medicare billing privileges at risk.

What You Need to Know:

The general rule is that you cannot reach out to Medicare beneficiaries by phone. However, there are 3 limited exceptions:

1. Where the individual has given you written permission to contact them by phone regarding the Medicare-covered item (e.g., prosthetic or bracing (orthotic) device);
2. The supplier has furnished the Medicare-covered item to the individual and is calling to coordinate delivery of that item; or
3. In the event that the supplier is calling about a Medicare-covered item other than one it has already delivered to the individual, the supplier must have previously furnished a Medicare-covered item to the beneficiary no more than 15 months before the telephone call.

What Does This Mean for You?

These restrictions exist to protect unscrupulous individuals from taking advantage of the elderly. Even if you are trying to contact a beneficiary in good faith, non-compliance with the limited exceptions listed above can create significant liability for your company. Make sure to train all employees who initiate telephone contact with your patients insured by Medicare. If you cannot satisfy the elements of one of the three exceptions, you must refrain from telephone solicitations and instead attempt to reach the patient via another method (e.g., snail mail) in order to remain compliant.

The rule on solicitating Medicare beneficiaries is one of the 30 supplier standards with which all suppliers must comply. Remember that you are also required to disclose those standards to every one of your patients who is insured by Medicare.

To see the complete list of supplier standards, click here.