Policy change regarding durable medical equipment rentals becomes effective Jan. 1, 2014

Effective Jan. 1, 2014, Blue Cross Blue Shield of Michigan will consider the effective date for durable medical equipment rentals to be the date that the member accepted delivery of the equipment — regardless of what health care carrier they had or if they had insurance at all at that time. This policy only applies when the health care carrier changes and the medical equipment supplier remains the same.

When a member’s carrier changes to Blue Cross during a DME rental period, providers will be required to continue the rental based on the original effective date for billing purposes and report the appropriate modifier.

See the chart below:

For capped rental items, we do not reimburse DME providers for rental payments that exceed the purchase price of each patient’s equipment. Blue Cross will continue to pay for rentals using a 10-month rent-to-purchase timeframe. 

For example:

A member has another health care carrier that reimburses for two months of rental for an item for which payment is capped at the purchase price. The DME provider must consider the amount previously paid with the other carrier when calculating additional billings to Blue Cross. If we determine that more was paid for the total rental period than the Blue Cross-approved purchase price of a capped item, we will initiate a recovery.

This policy also applies when a member’s coverage switches from a narrow network to a broader network and the provider is a member of both networks.

If you have questions about this policy, contact your provider consultant or refer to your billing manual on web-DENIS.