[cparks]

Where is the official ruling on a dme that accepts Medicare assignment being able to sell equipment as a retail item? I have always heard the dme could only sell, for example, a wheelchair for the Medicare allowable minus a reasonable percentage (25%??) for administrative fee.

[danielh]

The wheelchair is not a real good example, because Medicare doesn't pay for the purchase of wheelchairs. We've always been told that, in order to sell an item for less than Medicare allowable, the difference in sales price must be justified. Lower administrative costs and "cash up front" are the two primary motivations for discounting merchandise in a retail setting. If you are a Participating Provider, however, you don't have the option of submitting a claim unassigned so that's an entirely different problem. And, if you sell more of an item at a discount than at the allowable, the lower amount is technically your "usual and customary charge."