NEW MEDICARE REQUIREMENTS TAKE EFFECT FOR SUPPLIERS OF MEDICAL EQUIPMENT AND SUPPLIES
NEW STANDARDS PREVENT FRAUD AND PROMOTE QUALITY CARE
The Centers for Medicare & Medicaid Services (CMS) today issued a final reminder about new requirements for most suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) to meet new quality standards by Oct. 1 and obtain a surety bond by Oct. 2 as required under Federal law. These new supplier enrollment requirements will help to prevent fraud in Medicare and ensure that people with Medicare get high-quality medical items and services from qualified suppliers.
While the majority of Medicare beneficiaries will not be impacted by these new rules, people with Medicare should ask their suppliers if they are approved by Medicare to continue to ensure that Medicare will pay their claims. Suppliers must post notice if they are not accredited by Medicare or have the beneficiary sign an Advanced Beneficiary Notice (ABN) before they are charged for the items or service. Beneficiaries who need to find a new supplier can go to the “Find a Supplier” page at www.medicare.gov or call 1-800-MEDICARE.
In order to obtain or retain Medicare billing privileges, the law requires that DMEPOS suppliers become accredited by meeting the program’s business and product-specific service and quality standards. Business standards include how the company is run, how finances and staff performance are managed, how well the company takes care of its consumers, the safety of their products and whether the company’s information management systems are in place. Product-specific service standards include intake, delivery and setup, training and instruction of the beneficiary and/or their caregiver and follow-up service.
The vast majority of Medicare DMEPOS suppliers, many of which are pharmacies, have met the deadlines to apply and become accredited. As required in the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), suppliers that are not accredited will lose their billing privileges. However, there are some suppliers who, for various reasons, have submitted applications but have not yet completed the accreditation review process. CMS is continuing to work to complete the evaluations of those suppliers whose accreditation applications are still under review, which could take as long as 60 days. Suppliers wishing to participate in the Medicare DMEPOS competitive bidding program are reminded that they must be fully accredited to submit a bid.
CMS-deemed accreditation organizations have used these quality standards to evaluate the applications of thousands of DMEPOS suppliers during the past three years. More than 50,000 DMEPOS suppliers have already been accredited, which represents over 70 percent of current DMEPOS suppliers who would need to obtain accreditation. The requirement that CMS-deemed accreditation organizations apply quality standards to DMEPOS suppliers was enacted as part of the MMA.
The accreditation requirement applies to suppliers of durable medical equipment, medical supplies, home dialysis supplies and equipment, therapeutic shoes, parenteral/enteral nutrition, transfusion medicine and prosthetic devices, prosthetics and orthotics unless a professional exemption applies. Pharmacies, pedorthists, mastectomy fitters, orthopedic fitters/technicians and athletic trainers must also comply with the requirement. Congress is considering a provision that extends the deadline to January 1, 2010 for pharmacies to meet this accreditation requirement with the exception for those pharmacies that plan to bid in the DMEPOS competitive bidding program. Pharmacies that wish to participate in the DMEPOS competitive bidding program must be accredited in order to submit a bid.
The surety bond, required by the Balanced Budget Act of 1997, makes certain DMEPOS suppliers obtain and maintain a surety bond in the amount of $50,000. This requirement was due in part to the large number of improper and potentially fraudulent payments to medical equipment suppliers.
The surety bond requirement is designed to limit the Medicare program risk from fraudulent equipment suppliers and help to ensure that Medicare beneficiaries receive medical items that are considered reasonable and necessary from legitimate DMEPOS suppliers. Suppliers who have had certain final adverse actions imposed against them in the past, such as Medicare revocations, may also be required to post a higher bond amount.
More information about the accreditation and surety bond requirements for DMEPOS suppliers can be found at www.cms.hhs.gov/MedicareProviderSupEnroll.
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