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Qualifications

Medicare Supplier Standard

 

On August 27, 2010, the Centers for Medicare & Medicaid Services published a final rule titled, 'Medicare Program; Establishing Additional Medicare Durable Medical Equipment, Prothetics, Orthotics, and Supplies (DMEPOS) Supplier Enrollment Safeguards (CMS-6036-F)' in the Federal Register. This final rule clarifies and expands on the existing enrollment requirements that DMEPOS suppliers must meet to establish and maintain billing privileges in the Medicare program. We believe that these additions and revisions will help to ensure that only legitimate DMEPOS suppliers participate in the Medicare program and are furnishing items of DMEPOS to Medicare beneficiaries. This rule:

  • Requires DMEPOS suppliers to obtain oxygen from a state-licensed oxygen distributor (applicable only to those suppliers in states that require oxygen licensure (§424.57(c)(27))
  • Requires DMEPOS suppliers to maintain ordering and referring documentation consistent with the provisions found in §424.516(f) (§424.57(c)(28)). DMEPOS suppliers will be required to maintain written order from a physician or eligible professional.
  • Prohibits DMEPOS suppliers from sharing a practice location with certain other Medicare providers and suppliers (§424.57(c)(29)) except physician and non-physician practioners furnishing services to his or her own patient(s) as part of his or her professional service, occupational or physical therapists, and if the DME company is wholly owned by a Part A provider
  • Requires DMEPOS suppliers to remain open to the public for at least 30 hours a week, except physician, licensed non-physician practitioners furnishing services to his or her own patient(s) as part of his or her professional service, or a DMEPOS supplier working with custom made orthotics and prosthetics (§424.57(c)(30))
  • Requires DMEPOS suppliers to notify the National Supplier Clearinghouse (NSC) of an adverse legal action, change of location or change of ownership (including authorized and delegated officials) within 30 days. Failure to notify the NSC of these changes will result in overpayments from the date of the reportable event (§424.57(e)). In addition, this rule:
  • Revised supplier standard 1 (§424.57(c)(1)) to that suppliers meet all state licensure and regulatory requirements. If a state requires licensure to furnish certain items or services, a DMEPOS supplier:
    • Must be licensed to provide the item or service
    • Must employ the licensed professional on a full-time or part time basis, except for DMEPOS suppliers who are either:
      • Awarded competitive bid contracts using subcontractors to meet this standard
      • Allowed by the state to contract licensed services as described in paragraph (c)(1)(ii)(C) of this section
  • Revised supplier standard 7 (§424.57(c)(7)) to ensure that the DMEPOS supplier maintains a physical facility on an appropriate site. The appropriate site must meet the following:
    • Except for state-licensed orthotic and prosthetic personnel providing custom fabricated orthotics or prosthetics in private practice, maintain a practice location that is at least 200 square feet
    • Is in a location that is accessible to the public, Medicare beneficiaries, CMS, the NSC and its agents. The location must not be in a gated community or other area where access is restricted.
    • Is accessible and staffed during posted hours of operation
    • Maintains a permanent visible sign in plain view and posts hours of operation
    • Is in a location that contains space for storing businesses records, including the suppliers delivery, maintenance and beneficiary communication records
  • Revised supplier standard 9 (§424.57(c)(9)) to limit the use of cell phones, beeper numbers and pagers as a primary business telephone number. In addition, the exclusive use of answering machines and answering services as the primary telephone number by a DMEPOS supplier during posted business hours is prohibited.
  • Revised supplier standard 11 (§424.57(c)(11)) to clarify the requirements about direct solicitation