Applicable Provider Types: Any individual or entity that receives Medicare reimbursement for selling or renting DMEPOS
Is Your Entity in Compliance?
Suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) have unique Medicare enrollment requirements. To receive Medicare reimbursement for DMEPOS, a supplier must enroll each physical location it uses to furnish Medicare-covered DMEPOS, such as braces, wheelchairs or CPAP machines. Only locations solely used as warehouses or repair facilities are exempt from this requirement. Physician practices that offer DMEPOS cannot simply add a new location to their practice enrollment; they also need to enroll the new location as a DMEPOS location in the Medicare program. In addition, DMEPOS suppliers must revalidate their Medicare enrollment record every three years (by contrast, most other Medicare providers revalidate every five years). DMEPOS suppliers must also report any changes on their enrollment records, such as changes in ownership, address, authorized officials or products offered, within 30 days of such change.
Failure to enroll additional physical locations, revalidate or update applicable enrollment information within 30 days of a change can result in a DMEPOS supplier’s Medicare billing privileges being revoked. First time revocations can result in a ban on billing privileges from one to 10 years, while second time revocations can result in a 20-year ban.
Short of revocation, failure to enroll an additional physical location where DMEPOS is furnished with Medicare reimbursement could trigger penalties, including recoupment and obligations under the Medicare overpayments rule. The Medicare overpayments rule requires providers and suppliers to report and return any Medicare funds they received but were not entitled to within 60 days of the date that the overpayment was identified.
How to Confirm Compliance?
To avoid revocation or other liabilities, such as repayment obligations, DMEPOS suppliers should assess whether their Medicare enrollment information complies with applicable requirements and adhere to the following recommendations:
- Self-identify all locations where your entity is dispensing DMEPOS. This can include different suites in the same building, timeshare locations and offices where a provider sees patients.
- Login to your Provider, Enrollment, Chain and Ownership System (PECOS) account to verify all enrollment information. Ensure that you have a separate DMEPOS enrollment for each location identified in the first step. If any information on your enrollment record is out of date or incorrect, update such information accordingly.
- If a certain location is not enrolled in Medicare for DMEPOS, it can be added to an existing DMEPOS supplier’s enrollment record by following the directions in this Centers for Medicare & Medicaid Services (CMS) enrollment tutorial. Also, consider if past billing for this unenrolled location creates any potential exposure or liability.
- To enroll a new DMEPOS supplier entity (i.e., not a separate location associated with a previously enrolled entity), providers should (i) obtain a DMEPOS accreditation, (ii) apply for a National Provider Identifier for the relevant DMEPOS supplier location(s), (iii) complete the CMS-588 enrollment application, (iv) pay the Medicare application fee, and (v) post a $50,000 surety bond for each DMEPOS supplier location, unless an exception to the surety bond requirement applies (e.g., physicians that furnish DMEPOS supplies only to their own patients as part of the physician’s service fall under an exception to the surety bond requirement).
- Create a mechanism for tracking all Medicare enrollment records, which includes periodic PECOS logins to verify all enrollment records are up to date, including records for all enrolled DMEPOS locations.
- Add to your new location development checklist to enroll the new location as a Medicare DMEPOS location. Depending on your internal procedures, you may want to include the instructions in item 3 above.
If you need assistance ensuring that your DMEPOS locations are in compliance with Medicare enrollment requirements, McGuireWoods attorneys can assist.
Ounce of Prevention is a McGuireWoods series that details healthcare laws and regulations and offers tips on how providers can ensure they are in compliance. To recommend a topic for a future installment, email Gretchen Heinze Townshend at [email protected] or Tim Fry at [email protected].