WASHINGTON—The Centers for Medicare & Medicaid Services (CMS) on Aug. 26 issued a final rule strengthening enrollment standards medical suppliers must meet before being able to provide products to Medicare patients.
Medicare said the move will protect beneficiaries from potentially fraudulent suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).
“We know the majority of medical equipment suppliers and healthcare providers want to improve the health of Medicare beneficiaries, but we also know there are those who look for any opportunity to take advantage of beneficiaries and Medicare, including sham operations who are not legitimate businesses,” said CMS Deputy Administrator for Program Integrity, Peter Budetti. “The steps we are taking today provide us with additional tools to support our continuing efforts to reduce Medicare fraud by helping to ensure that only appropriately qualified suppliers are enrolled in the program.”
The additions and revisions to the DMEPOS supplier enrollment standards help ensure that only qualified and legitimate DMEPOS suppliers participate in Medicare. All suppliers for these items, including those DMEPOS items prescribed by the beneficiary’s physician, from simple canes and walkers to complex power wheelchairs, oxygen supplies and equipment, and hospital beds now must meet these new standards.
This final rule will:
- Require DMEPOS suppliers to obtain oxygen from a state-licensed oxygen supplier (applies only in states that require oxygen licensure).
- Require DMEPOS suppliers to remain open to the public for at least 30 hours a week, with exceptions for physicians or licensed non-physician practitioners furnishing services to their own patient(s) as part of their professional service, and DMEPOS suppliers working with custom made orthotics and prosthetics.
- Ensure that DMEPOS suppliers continue to maintain ordering and referring documentation from physicians or non-physician practitioners.
- Prohibit DMEPOS suppliers from sharing a practice location with certain other Medicare providers and suppliers subject to certain exceptions.
The final rule also clarifies and expands the existing enrollment requirements that DMEPOS suppliers must meet to establish and maintain billing privileges in the Medicare program. Specifically, this final rule will revise current supplier standards to ensure that the DMEPOS supplier maintains a physical facility on an appropriate site.
A copy of the final rule is posted on the Federal Register site at: http://www.ofr.gov/OFRUpload/OFRData/2010-21354_PI.pdf
