Suppliers of Durable Medical Equipment, Prosthetics and Orthotics, and Supplies (“DMEPOS”)
Medicare allows for enrollment of several different DMEPOS supplier types. DMEPOS suppliers are subject to a vast number of federal, state, and accreditation requirements. While Medicare fee-for-service improper payment rates for DMEPOS have been trending downward in recent years, DMEPOS claims still have the highest percentage of improper payment rates when compared to other Medicare claim types. In addition, maintaining a current and accurate Medicare enrollment record is important to continuation of Medicare billing privileges. Considering the improper payment statistics and Medicare enrollment record maintenance requirements, it is imperative that DMEPOS suppliers establish and maintain a baseline of compliance with these complex standards.
DMEPOS suppliers should give consideration to the following:
- State License – Determine the license requirements of states in which the supplier operates.
- Accreditation – In general, to enroll in Medicare as a DMEPOS supplier, the entity must first be accredited by a CMS-approved Accrediting Organization (“AO”). Concurrent with determining state license requirements, the DMEPOS supplier should also review accreditation requirements and select an AO. DMEPOS suppliers must maintain an accurate and current accreditation record.
- Medicare Certification and Quality – From a Medicare standpoint, DMEPOS suppliers must meet various Medicare requirements at 42 CFR 424.57 and the DMEPOS Quality Standards (which include supplier business service requirements and supplier product-specific service requirements).
- Medicare Enrollment – After obtaining a state license and accreditation (if required), DMEPOS suppliers may submit an application to enroll in Medicare. DMEPOS suppliers enroll in Medicare via the CMS-855S Medicare Enrollment Application. There are specific insurance and surety bond requirements that should be carefully reviewed.
- Medicaid and Commercial Payers – DMEPOS suppliers intending to enroll in Medicaid programs or contract with commercial payers will also be required to complete an enrollment process that may have some similarities to the Medicare process identified above. Due to the multitude of varying requirements, DMEPOS should review and understand specific program or contractual requirements in addition to those required of Medicare.
