Final Rule Establishes New DMEPOS Enrollment Standards

The Centers for Medicare & Medicaid Services (CMS) issued a final rule Aug. 27 entitled “Medicare Program; establishing Additional Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Supplier Enrollment Safeguards (CMS-6036-F).” The final rule implements several Patient Protection and Affordable Care Act (Affordable Care Act) requirements designed to prevent and detect fraud, waste, and abuse in the Medicare and Medicaid programs, and to ensure quality care for beneficiaries.

“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. “The steps we are taking today provide us with additional tools to support our continuing efforts to reduce Medicare fraud by helping to ensure that only appropriately qualified suppliers are enrolled in the program.”

Effective Sept. 27, the final rule:

  • Requires DMEPOS suppliers to obtain oxygen from a state-licensed oxygen supplier (applies only in states that require oxygen licensure).
  • Requires 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 orthotics and prosthetics.
  • Ensures that DMEPOS suppliers continue to maintain ordering and referring documentation from physicians or non-physician practitioners.
  • Prohibits 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, 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; and
  • 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. 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-mails, instant messaging and Internet coercive advertising.

A copy of the final rule is posted on the Federal Register site.

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