Medicare

Note: This is a condensed summary of the supplier standards that every Medicare DMEPOS supplier must meet to obtain and maintain billing privileges. The full version of these standards can be found in 42 C.F.R. 424.57(c).

• Suppliers must comply with all applicable federal and state licensing and regulatory laws and cannot subcontract with individuals or entities to perform licensed services.
• Suppliers are required to provide accurate and complete information on their DMEPOS supplier application and report any updates to the National Supplier Clearinghouse within 30 days.
• An authorized representative—someone whose signature is legally binding—must sign the billing privilege application.
• Suppliers must either fill orders from their own inventory or work with other companies to obtain necessary items. They cannot contract with any organization currently excluded from Medicare, state healthcare programs, or other federal programs.
• Suppliers must inform beneficiaries of their options to rent or buy durable medical equipment that is inexpensive or routinely purchased, including purchase options for capped rental items.
• Suppliers must notify beneficiaries about warranty coverage, honor all applicable warranties, and repair or replace—free of charge—any Medicare-covered items under warranty.
• A supplier must operate a physical facility at a proper location that is accessible to the public, staffed during posted business hours, and clearly marked with signage. The site must be at least 200 square feet and include space for record storage.
• CMS or its agents must be allowed to perform on-site inspections to verify compliance with these standards.
• The supplier must have a listed business telephone number under its company name in a local directory or a toll-free number accessible through directory assistance. Solely using a beeper, answering service, or cell phone during business hours is not allowed.
• Suppliers must maintain liability insurance of at least $300,000, covering their business premises, employees, and customers. Those manufacturing their own products must also carry product liability insurance.
• Suppliers are not permitted to initiate phone contact with beneficiaries, except under specific, approved exceptions. They may not call based solely on a physician’s verbal order unless an exception applies.
• Suppliers are responsible for delivering Medicare-covered items, educating beneficiaries on their proper use, and maintaining proof of delivery.
• Suppliers must address beneficiary inquiries and complaints, keeping records of all such interactions.
• Suppliers must repair or replace, at no cost, any Medicare-covered rental equipment, either directly or through a service contract.
• Suppliers must accept returns of items that are substandard or unsuitable for the beneficiary’s needs at the time of fitting, rental, or sale.
• Suppliers must disclose these standards to every beneficiary receiving a Medicare-covered item.
• Suppliers must inform the government of any individuals with ownership, financial, or control interests in the business.
• Suppliers cannot transfer, sell, or allow the use of their Medicare supplier number by another entity.
• Suppliers must have a formal complaint resolution process for handling beneficiary concerns, with complaint records maintained on-site.
• Complaint logs must include the beneficiary’s name, address, phone number, health insurance claim number, a summary of the complaint, and actions taken.
• Suppliers must provide CMS with any requested information as required under Medicare law and regulations.
• All suppliers must be accredited by a CMS-approved accreditation organization to receive and maintain a billing number. Accreditation must specify which products and services are covered for payment eligibility (with certain pharmaceutical exceptions). Implementation Date: October 1, 2009.
• Suppliers must inform their accreditation organization when opening a new DMEPOS location.
• Every supplier location, owned or subcontracted, must independently meet DMEPOS quality standards and hold separate accreditation to bill Medicare.
• Upon enrollment, suppliers must disclose all products and services, including any new product lines added for accreditation.
• Suppliers must meet surety bond requirements as stated in 42 C.F.R. 424.57(c). Implementation Date: May 4, 2009.
• Suppliers must obtain oxygen only from state-licensed oxygen suppliers.
• Suppliers must maintain ordering and referring documentation as specified under 42 C.F.R. 424.516(f).
• DMEPOS suppliers cannot share a business location with certain other Medicare providers or suppliers.
• DMEPOS suppliers must be open to the public for at least 30 hours per week, with limited exceptions.