Effective February 27, CMS instituted the DMEPOS enrollment moratorium to manage reports of fraud and abuse within that system. The moratorium had a planned expiration after six months, which as of the date of this writing, has not been extended, although CMS does have the authority to do so at its discretion.
The DMEPOS enrollment moratorium is a temporary regulatory action that halts the enrollment of certain suppliers in Medicare. CMS uses such moratoria as a front-end program integrity tool, shifting post-payment enforcement to preventive controls that stop high-risk entities before they enter the program. Unfortunately, this moratorium is unlikely to result in a reduction in post-payment claims reviews.
The impact of this moratorium on O&P suppliers is entirely dependent on the supplier type designated on the CMS-855S enrollment application in PECOS; Section 2. E. 1. Only existing DMEPOS suppliers or new enrolling suppliers that are identified as the following supplier types will be impacted by the moratorium at this time:
- Medical supply company
- Medical supply company with orthotics personnel
- Medical supply company with pedorthics personnel
- Medical supply company with prosthetics personnel
- Medical supply company with prosthetics and orthotics personnel
- Medical supply company with registered pharmacists
- Medical supply company with respiratory therapists
If your CMS-855S identifies your company as orthotics personnel, pedorthics personnel, prosthetics personnel, or prosthetics and orthotics personnel, this moratorium does not directly impact you at this time.
If your company is identified as one of the medical supply company supplier types impacted by the moratorium, this would affect new supplier enrollments, the addition of new locations, and certain types of change of ownership. This would also impact suppliers trying to change their supplier type designation from one of the identified medical supply company types to another supplier type, not impacted by the moratorium (and vice versa). For example, a supplier currently identified as a medical supply company with prosthetics and orthotics personnel on their CMS-855S cannot change their supplier type to prosthetics and orthotics personnel during the moratorium to circumvent it.
New supplier enrollments submitted during the moratorium whose business model suggests that their primary function is the furnishing of DMEPOS supplies regardless of the supplier type designation chosen on their CMS-855S could still see dismissal of their enrollment application. CMS has given Medicare Enrollment Contractors direction to scrutinize these applications more closely for potential fraud. Therefore, enrollment applications and changes may be dismissed based on more than just the identified supplier type.
CMS has made it clear that this moratorium is intended to block entry of high-risk supplier categories to deter would-be fraudulent entities from becoming enrolled DMEPOS suppliers, endangering beneficiaries and the Medicare trust fund. This moratorium is partially due to the high rate of revocations, payment suspensions, and investigations amongst new supplier enrollees.
Despite being a deterrent to would-be fraudulent suppliers, these changes are significantly impacting existing DMEPOS suppliers and their ability to run their businesses effectively. Over the past year, Medicare has seen an increase in supplier Provider Transaction Access Number (PTAN) deactivations and enrollment revocations, some of which have been due to technicalities with revalidations and/or site visit issues. Some of the reasons we’ve seen for these actions include failed site visits, missed revalidation deadlines, or outdated liability insurance, surety bond, and/or accreditation, or missing certifications/licensures. Suppliers are encouraged to be proactive to prevent these revocations and deactivations.
Prepare for Medicare Revalidation
- Know your revalidation date
- Submit your revalidation up to six months prior to the due date
- Ensure that the authorized official or delegated official listed on your supplier file signs revalidation paperwork
- Include your NPI Enumerator Notification with your revalidation paperwork (required), which must have your business name and physical address for the location revalidation
- Be sure to include a contact person in Section 11 of the CMS-855S in the event the enrollment analyst has questions about your revalidation
- Include the underwriter’s contact information so the analyst can verify your insurance coverage
Checklist for Site Visit
- Licensure/certifications
- Proof of liability insurance
- Complaint resolution protocol and complaint log
- Warranty coverage notification
- Rent/purchase option notification
- List of all owners/management, including names/titles
- Surety bond agreement
- Accreditation information
- Written instruction information on beneficiary use/maintenance of items
- Evidence of onsite inventory
- Posted signage with legal business name (or DBA) and hours of operation
Being proactive with revalidation and site visit requirements can avoid unnecessary PTAN deactivations and enrollment revocations.
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Lesleigh Sisson, CFo, CFm, and Curt Bertram, CPO, are part of the leadership team at O&P Insight. Sisson and Bertram have a combined 64 years of experience in O&P administration, clinical services, and operational management. You can contact them at lesleigh@oandpinsight.com or curt@oandpinsight.com. Michelle Wullstein, CPCO, has been in the Medicare profession for over 18 years and is an AAPC-certified professional compliance officer and provides O&P-specific medical policy, billing, documentation, and HIPAA compliance support to internal teams and clients. While every attempt has been made to ensure accuracy, The O&P EDGE is not responsible for errors.
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