CMS PROPOSES STRONGER PROTECTIONS FOR BENEFICIARIES USING DURABLE MEDICAL EQUIPMENT, PROSTHETICS, ORTHOTICS, AND SUPPLIES
The Centers for Medicare & Medicaid Services (CMS) on January 25 issued a proposed rule to enhance the enrollment standards for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers. The proposed rule is intended to increase protections for Medicare and its beneficiaries from potentially dishonest or low quality suppliers.
By creating five new standards and strengthening seven of the 21 existing standards that suppliers must meet, the proposed rule would provide Medicare beneficiaries with additional assurance that they are being served by suppliers who meet the highest standards of quality.
“The proposals represent the next step in Medicare’s ongoing efforts to ensure its beneficiaries continue to have access to high quality products and services at appropriate prices, while protecting them and the program from unscrupulous suppliers,” said CMS Acting Administrator Kerry Weems. “In addition to meeting the enrollment standards, all DMEPOS suppliers are required to obtain accreditation from one of ten accrediting organizations announced in November 2006.”
Proposed requirements and deadlines for obtaining accreditation are as follows:
- Suppliers in the DMEPOS competitive bidding areas must be accredited before CMS can contract with them as winning bidders.
- New suppliers, who apply to the National Supplier Clearinghouse (NSC) for a supplier number before March 1, 2008, must be accredited by December 31, 2008. The NSC is the organization that issues DMEPOS billing numbers and maintains information about all suppliers enrolled in Medicare.
- New suppliers who apply for a supplier number on or after March 1, 2008, must be accredited before they can get a supplier number.
- All other suppliers must be accredited by September 30, 2009.
The proposed additions and revisions to the DMEPOS supplier enrollment standards are expected to help ensure that only legitimate DMEPOS suppliers participate in Medicare.
The enrollment standards would affect all suppliers for these items, not just those who participating in the durable medical equipment bidding program. The standards also will apply to suppliers of all types of DMEPOS prescribed by the beneficiary’s physician, from simple canes and walkers to complex power wheelchairs, oxygen supplies and equipment, and hospital beds.
One of the new standards would require DMEPOS suppliers, except suppliers of prosthetics and orthotics, to be open to the public for at least 30 hours a week. In addition, the proposed new standards would:
- Require DMEPOS suppliers to notify the NSC of any adverse legal action, change of location, and change of ownership. A supplier who fails to report the required information within 30 days would not be eligible to receive Medicare payments, and any payments received by the supplier while out of compliance would be treated as overpayments and will need to be returned to Medicare.
- Prohibit suppliers from sharing a practice location with another Medicare supplier;
- Require suppliers to maintain ordering and referring documentation received from the physician or other treating profession for seven years; and
- Prohibit DMEPOS suppliers that have a Federal or state tax delinquency from obtaining billing privileges or retaining billing privileges they have already been granted.
The proposed rule would also strengthen existing standards by:
- Requiring that suppliers maintain a location or office at an appropriate site where they store business records and retain documentation of orders and referrals;
- Requiring that the NSC be listed as a certificate holder on the comprehensive liability insurance policy;
- Expanding the existing limitation on when and how a supplier may contact Medicare beneficiaries; and
- Limiting the use of cell phones, beeper numbers, pagers, and the exclusive use of answering machines and services as the primary business telephone number during posted hours of operation.
“CMS is committed to ensuring that Medicare beneficiaries are confident that the DMEPOS suppliers from whom they obtain these items are honest businesses and that they are getting quality equipment, prosthetics, orthotics, and supplies at fair prices,” said Weems. “In a related effort, CMS is in the process of launching a new DMEPOS competitive bidding program that will save money for Medicare and for beneficiaries paying a coinsurance of 20 percent of the cost of a DMEPOS item, while improving quality.”
The proposed rule was published in the January 25, 2008, Federal Register. Comments will be accepted until March 25, and a final rule will be published later this year.
Related Web sites: A copy of the proposed rule is posted on the Federal Register site at:
http://a257.g.akamaitech.net/7/257/2422/25jan20081800/edocket.access.gpo.gov/2008/pdf/E8-1346.pdf
The current supplier enrollment standards can be found on the National Supplier Clearinghouse’s Web site at:
Names and contact information for the DMEPOS accrediting organizations can be found at: www.cms.hhs.gov/center/dme.asp and clicking on the link for Deemed Accreditation Organizations for Suppliers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
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