The Centers for Medicare & Medicaid Services (CMS) issued a final rule on Medicare enrollment standards for providers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).
The new regulation clarifies, expands, and adds to the existing enrollment requirements that DMEPOS providers must meet before being able to furnish equipment and supplies to Medicare beneficiaries and to establish and maintain Medicare billing privileges. CMS said that these new and stronger standards are designed to reduce fraud in Medicare and provide beneficiaries with additional assurance that they are being served by legitimate suppliers who meet Medicare’s standards.
“We know the majority of medical equipment suppliers and health care providers want to improve the health of Medicare beneficiaries, but we also know there are those who look for any opportunity to take advantage of beneficiaries and Medicare, including sham operations who are not legitimate businesses,” said CMS Deputy Administrator for Program Integrity, Peter Budetti.
All DMEPOS suppliers, including those items prescribed by the beneficiary’s physician, from simple canes and walkers to complex power wheelchairs, oxygen supplies and equipment, and hospital beds now must meet these new standards. According to CMS, this final rule will:
- Require DMEPOS suppliers to obtain oxygen from a state-licensed oxygen supplier (applies only in states that require oxygen licensure).
- Require DMEPOS suppliers to remain open to the public for at least 30 hours a week, with exceptions for physicians or licensed non-physician practitioners furnishing services to their own patient(s) as part of their professional service, and DMEPOS suppliers working with custom-made orthotic and prosthetic devices.
- Ensure that DMEPOS suppliers continue to maintain ordering and referring documentation from physicians or non-physician practitioners.
- Prohibit DMEPOS suppliers from sharing a practice location with certain other Medicare providers and suppliers subject to certain exceptions.
The final rule also clarifies and expands the existing enrollment requirements that DMEPOS suppliers must meet to establish and maintain billing privileges in the Medicare program. Specifically, this final rule revises current supplier standards to:
- Ensure that the DMEPOS supplier maintains a physical facility on an appropriate site that must:
- Measure at least 200 square feet, except for state-licensed orthotic and prosthetic personnel providing custom fabricated orthotics or prosthetics in private practice.
- Be in a location that is accessible to the public, Medicare beneficiaries, CMS, and the National Supplier Clearinghouse (NSC) and its agents (not in a gated community or other area where access is restricted).
- Be accessible and staffed during posted hours of operation.
- Maintain a permanent visible sign in plain view and post hours of operation.
- Be in a location that contains space for storing business records, including the supplier’s delivery, maintenance, and beneficiary communication records.
- Prohibit the use of cell phones, beeper numbers, and pagers as a primary business telephone number. In addition, answering machines and answering services may not be used exclusively as a supplier’s primary telephone number during posted business hours.
- Expand the prohibition on a DMEPOS supplier’s telephone solicitation of a Medicare beneficiary to also include in-person contacts, e-mail messages, instant messaging, and Internet coercive advertising.
To read the complete final ruling, click here.