LEEDer Group Inc.
8508 North West 66th St.
Miami, Florida 33166 USA

Phone: 305.436.5030
Fax: 305.436.0086
E-mail Address: info {at] LEEDerGroup [dot] com

2011-02 Expansion of Durable Medical Equipment (DME) Supplier Standards SE1032





MLN Matters® Number: SE1032 Related Change Request (CR) #: N/A
Related CR Release Date: N/A Effective Date: N/A
Related CR Transmittal #: N/A Implementation Date: N/A
Expansion of Durable Medical Equipment (DME) Supplier Standards

  • Provider Types Affected
    Suppliers of Durable Medical Equipment, Prosthetics, Orthotics and Supplies
    (DMEPOS) submitting claims to Medicare DME Medicare Administrative
    Contractors (MACs) for services provided to Medicare beneficiaries are impacted
    by this Special Edition (SE) 1032.
  • Provider Action Needed
    This article alerts suppliers that the Centers for Medicare & Medicaid Services
    (CMS) expanded the enrollment standards that DMEPOS suppliers must meet in
    order to establish and/or maintain billing privileges in the Medicare Program. CMS
    issued these revisions to ensure that only legitimate DMEPOS suppliers
    participate in the Medicare program and are providing DMEPOS items to Medicare
    beneficiaries. Be certain your billing staffs are aware of these changes.
  • Background
    On August 27, 2010 CMS published a final rule titled, Medicare Program;
    Establishing Additional Medicare Durable Medical Equipment, Prosthetics,
    Orthotics, and Supplies (DMEPOS) Supplier Enrollment Safeguards (CMS-6036-
    F) in the Federal Register. This final rule, effective September 27, 2010, may be reviewed at 2010-21354.pdf on the Internet. This final rule clarifies, expands, and adds to the existing enrollment requirements that DMEPOS suppliers must meet to establish and maintain billing privileges in the Medicare program.

Key Points of SE1032: The Medicare Program; Establishing Additional Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Supplier Enrollment Safeguards rule does the following:
  • Requires DMEPOS suppliers to obtain oxygen from a State-licensed oxygen supplier (applicable only to those suppliers in States that require oxygen licensure (Section 424.57©(27));
  • Requires DMEPOS suppliers to maintain ordering and referring documentation
    consistent with the provisions found in Section 424.516(f) (§424.57©(28)). (DMEPOS supplier will be required to maintain written order from a physician or eligible professional.);
  • Prohibits DMEPOS suppliers from sharing a practice location with certain
    other Medicare providers and suppliers (Section 424.57©(29));
  • Requires DMEPOS suppliers to remain open to the public for at least 30 hours
    a week, except physician, licensed non-physician practitioners furnishing
    services to his or her own patient(s) as part of his or her professional service,
    or a DMEPOS supplier working with custom made orthotics and prosthetics
    (Section 424.57©(30)); and
  • Requires DMEPOS suppliers to notify the National Supplier Clearinghouse
    (NSC) of an adverse legal action, change of location, or change of ownership
    (including authorized and delegated officials) within 30 days. Failure to notify the NSC of these changes will result in overpayments from the date of the
    reportable event (Section 424.57(e));
  • Revises supplier standard 1 (Section 424.57©(1)) requiring suppliers meet all
    state licensure and regulatory requirements. If a State requires licensure to
    furnish certain items or services, a DMEPOS supplier must be licensed to
    provide the item or service, and must employ the licensed professional on a
    full-time or part time basis unless the State permits contracting for licensed
    services. A supplier may contract with an individual or other entity to provide
    licensed services unless State law expressly prohibits such an arrangement.
  • Revises supplier standard 7 (Section 424.57©(7)) to ensure that the
    DMEPOS supplier maintains a physical facility on an appropriate site. The
    appropriate site must meet the following:
    1. Except for State-licensed orthotic and prosthetic personnel providing
      custom fabricated orthotics or prosthetics in private practice, maintain
      a practice location that is at least 200 square feet;
    2. Is in a location that is accessible to the public, Medicare beneficiaries,
      CMS, the NSC and its agents. The location must not be in a gated
      community or other area where access is restricted;
    3. Is accessible and staffed during posted hours of operation;
    4. Maintains a permanent visible sign in plain view and posts hours of
      operation; and
    5. Is in a location that contains space for storing businesses records,
      including the supplier’s delivery, maintenance and beneficiary
      communication records.
    6. Revises supplier standard 9 (Section 424.57©(9))
      to limit the use of cell phones, beeper numbers, and pagers as a primary business telephone number. In addition, the exclusive use of answering machines and answering services as the primary telephone number by a DMEPOS supplier during
      posted business hours is prohibited.
    7. Additional Information
      Remember, your Medicare contractor is available to assist you in providing
      services to Medicare beneficiaries and in being reimbursed in a timely manner for
      those services. Whenever you have questions, contact your contractor at their toll free number, which is available at-CLICK HERE on the CMS website.

If you have questions related to enrollment or accrediting standards issues, please
contact the NSC at (866) 238-9652 from 9 a.m. until 5 p.m. EST to reach a
customer service representative.

Medicare’s surety bond requirements are summarized in detail in article MM6392 at-CLICK HERE on the CMS website.

More information regarding accreditation can be found at the provider/supplier accreditation page located at-CLICK HERE on the CMS website.