CMS Proposes New Protections for Beneficiaries Using DMEPOS Suppliers

On Jan. 25, the Centers for Medicare and Medicaid Services (CMS) proposed improvements to augment current enrollment standards for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) suppliers.

“By creating five new standards and strengthening seven of the 21 existing standards that suppliers must meet, the proposed rule would provide Medicare beneficiaries with additional assurance that they are being served by suppliers who meet the highest standards of quality,” CMS stated in a press release.

Proposed requirements and deadlines

“The proposals represent the next step in Medicare’s ongoing efforts to ensure its beneficiaries continue to have access to high quality products and services at appropriate prices, while protecting them and the program from unscrupulous suppliers,” Kerry Weems, CMS acting administrator said. “In addition to meeting the enrollment standards, all DMEPOS suppliers are required to obtain accreditation from one of ten accrediting organizations announced in November 2006.”

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Proposed requirements and deadlines for obtaining accreditation are as follows:

  • Suppliers in the DMEPOS competitive bidding areas must be accredited before CMS can contract with them as winning bidders.
  • New suppliers, who applied to the National Supplier Clearinghouse (NSC) for a supplier number before March 1 must be accredited by Dec. 31. The NSC is the organization that issues DMEPOS billing numbers and maintains information about all suppliers enrolled in Medicare.
  • New suppliers who apply for a supplier number on or after March 1, must be accredited before they can get a supplier number.
  • All other suppliers must be accredited by Sept. 30, 2009.

Proposed revisions

The proposed rule would also strengthen existing standards by:

  • Requiring that suppliers maintain a location or office at an appropriate site where they store business records and retain documentation of orders and referrals
  • Requiring that the NSC be listed as a certificate holder on the comprehensive liability insurance policy
  • Expanding the existing limitation on when and how a supplier may contact Medicare beneficiaries
  • Limiting the use of cell phones, beeper numbers, pagers, and the exclusive use of answering machines and services as the primary business telephone number during posted hours of operation.

Proposed additions

The enrollment standards would affect all suppliers for these items, not just those participating in the durable medical equipment bidding program.
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One of the new standards would require DMEPOS suppliers, except suppliers of prosthetics and orthotics, to be open to the public for at least 30 hours a week. In addition, the proposed new standards would:

  • Require DMEPOS suppliers to notify the NSC of any adverse legal action, change of location, and change of ownership. A supplier who fails to report the required information within 30 days would not be eligible to receive Medicare payments, and any payments received by the supplier while out of compliance would be treated as overpayments and will need to be returned to Medicare
  • Prohibit suppliers from sharing a practice location with another Medicare supplier
  • Require suppliers to maintain ordering and referring documentation received from the physician or other treating profession for 7 years
  • Prohibit DMEPOS suppliers that have a federal or state tax delinquency from obtaining billing privileges or retaining billing privileges they have already been granted.

The press release also stated that, “the enrollment standards would affect all suppliers for these items, not just those participating in the durable medical equipment bidding program. The standards also will apply to suppliers of all types of DMEPOS prescribed by the beneficiary’s physician, from simple canes and walkers to complex power wheelchairs, oxygen supplies and equipment, and hospital beds.”

“CMS is committed to ensuring that Medicare beneficiaries are confident that the DMEPOS suppliers from whom they obtain these items are honest businesses and that they are getting quality equipment, prosthetics, orthotics, and supplies at fair prices,” Weems said. “In a related effort, CMS is in the process of launching a new DMEPOS competitive bidding program that will save money for Medicare and for beneficiaries paying a coinsurance of 20% of the cost of a DMEPOS item, while improving quality.”

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