In a new Proposed Rule Fact Sheet, the Centers for Medicare & Medicaid Services (CMS) recommended that accredited durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) providers who bill Medicare be resurveyed and renewed annually rather than the current three-year renewal period.
“We are particularly concerned that there may be instances where: (1) AOs [accrediting organizations] are accrediting DMEPOS suppliers that do not meet the DMEPOS quality standards; and (2) DMEPOS suppliers are falling out of compliance with the quality standards (sometimes for extended periods) after becoming accredited,” the proposal said. “As a result, we are concerned for beneficiaries’ health and safety when they utilize such suppliers, as well as for the many millions of Medicare dollars that may have been paid to noncompliant suppliers since 2006. Therefore, we are proposing to update and enhance our regulations so we can exercise greater scrutiny over DMEPOS suppliers and the AOs.”
CMS is proposing “increasing the amount, specificity, and frequency of data that AOs must submit to CMS; expanding CMS’ ability to closely monitor and review AOs’ operations; and strengthening CMS’s ability to act against poorly performing AOs.”
CMS also proposed that DMEPOS suppliers that achieve an approval rate of 90 percent can become exempt from prior authorization.
“To determine supplier eligibility for continued exemption, the DME Medicare Administrative Contractors (DME MACs) would complete a post-payment medical review sample. From this claim sample, suppliers must again meet a claim approval rate of 90 percent or greater to continue their exemption. Suppliers who did not meet the compliance rate threshold must continue submitting prior authorization requests as required,” CMS said.
Comments can be made to the proposed rule for 60 days after it is published in the Federal Register, which is expected to occur on July 2.
To read the “Calendar Year 2026 Home Health Prospective Payment System Proposed Rule Fact Sheet, CMS-1828-P,” visit the CMS website.
