CMS DMEPOS Supplier Standards
Note: This list is an abbreviated version of the application certification standards that every Medicare DMEPOS supplier must meet in order to obtain and retain their billing privileges. These standards, in their entirety, are listed in 42 C.F.R. pt. 424, sec 424.57(c) and were effective on December 11, 2000.
1. A supplier must be in compliance with all applicable Federal and State licensure and regulatory requirements.
2. A supplier must provide complete and accurate information on the DMEPOS supplier application. Any changes to this information must be reported to the National Supplier Clearinghouse within 30 days.
3. An authorized individual (one whose signature is binding) must sign the application for billing privileges.
4. A supplier must fill orders from its own inventory, or must contract with other companies for the purchase of items necessary to fill the order. A supplier may not contract with any entity that is currently excluded from the Medicare program, any State health care programs, or from any other Federal procurement or non-procurement programs.
5. A supplier must advise beneficiaries that they may rent or purchase inexpensive or routinely purchased durable medical equipment, and of the purchase option for capped rental equipment.
6. A supplier must notify beneficiaries of warranty coverage and honor all warranties under applicable State law, and repair or replace free of charge Medicare-covered items that are under warranty.
7. A supplier must maintain a physical facility on an appropriate site.
8. A supplier must permit CMS or its agents to conduct on-site inspections to ascertain the supplier’s compliance with these standards. The supplier location must be accessible to beneficiaries during reasonable business hours, and must maintain a visible sign and posted hours of operation.
9. A supplier must maintain a primary business telephone listed under the name of the business in a local directory or a toll free number available through directory assistance. The exclusive use of a beeper, answering machine, or cell phone is prohibited.
10. A supplier must have comprehensive liability insurance in the amount of at least $300,000 that covers both the supplier’s place of business and all customers and employees of the supplier. If the supplier manufactures its own items, this insurance must also cover product liability and completed operations. Failure to maintain required insurance at all times will result in revocation of the supplier’s billing privileges retroactive to the date the insurance lapsed.
11. A supplier must agree not to initiate telephone contact with beneficiaries, with a few exceptions allowed. This standard prohibits suppliers from calling beneficiaries in order to solicit new business.
12. A supplier is responsible for delivery, must instruct beneficiaries on the use of Medicare-covered items, and maintain proof of delivery.
13. A supplier must answer questions and respond to complaints of beneficiaries, and maintain documentation of such contacts.
14. A supplier must maintain and replace at no charge or repair directly, or through a service contract with another company, Medicare-covered items it has rented to beneficiaries.
15. A supplier must accept returns of substandard (less than full quality for the particular item) or unsuitable items (inappropriate for the beneficiary at the time it was fitted and rented or sold) from beneficiaries.
16. A supplier must disclose these supplier standards to each beneficiary to whom it supplies a Medicare-covered item.
17. A supplier must disclose to the government any person having ownership, financial, or control interest in the supplier.
18. A supplier must not convey or reassign a supplier number; i.e. the supplier may not sell or allow another entity to use its Medicare Supplier Billing Number.
19. A supplier must have a complaint resolution protocol established to address beneficiary complaints that relate to these standards. A record of these complaints must be maintained at the physical facility.
20. Complaint records must include: the name, address, telephone number and health insurance claim number of the beneficiary, a summary of the complaint, and any actions taken to resolve it.
21. A supplier must agree to furnish CMS any information required by the Medicare statute and implementing regulations.
22. All suppliers of DMEPOS and other items and services must be accredited by a CMS-approved accreditation organization in order to receive and retain a supplier billing number. The accreditation must indicate the specific products and services, for which the supplier is accredited in order for the supplier to receive payment for those specific products and services.
23. All DMEPOS suppliers must notify their accreditation organization when a new DMEPOS location is opened. The accreditation organization may accredit the supplier location for three months after it is operational without requiring a new site visit.
24. All DMEPOS supplier locations, whether owned or subcontracted, must meet the DMEPOS quality standards and be separately accredited in order to bill the Medicare. An accredited supplier may be denied enrollment or their enrollment may be revoked, if CMS determines that they are not in compliance with the DMEPOS quality standards.
25. All DMEPOS suppliers must disclose upon enrollment all products and services, including the addition of new product lines for which they are seeking accreditation. If a new product line is added after enrollment, the DMEPOS supplier will be responsible for notifying the accrediting body of the new product so that the DMEPOS supplier can be re-surveyed and accredited for these new products.
THE FOLLOWING NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THE INFORMATION CAREFULLY.
~ Your confidential healthcare information (PHI) may be released to other healthcare professionals within WHB for the purpose of providing you with quality healthcare.
~ Your PHI may be released to your insurance provider for the purpose of WHB receiving payment for providing you with needed healthcare services.
~ Your PHI may be released to public or law enforcement officials in the event of an investigation in which you are a victim of abuse, a crime or domestic violence.
~ Your PHI may be released to other healthcare providers in the event you need emergency care.
~ Your PHI may be released to a pubic health organization or federal organization in the event of a communicable disease or to report a defective device or untoward event to a biological product (food or medication).
~ Your PHI may not be released for any other purpose than that which is identified in this notice.
~ Your PHI may be released only after receiving written authorization from you. You may revoke your permission to release PHI at any time.
~ You may be contacted by WHB to remind you of any appointments, healthcare treatment options or other health services that may be of interest to you.
~ You may be contacted by WHB for the purposes of raising funds to support WHB’s operations.
~ You have the right to restrict the use of your PHI. However, WHB may choose to refuse your restriction if it is in conflict of providing you with quality healthcare or in the event of an emergency situation.
~ You have the right to receive confidential communication about your health services.
~ You have the right to review and photocopy any/all portions of your healthcare information.
~ You have the right to make changes to your healthcare information.
~ You have the right to know who has accessed your PHI and for what purpose.
~ You have the right to possess a copy of this Privacy Notice upon request. This copy can be in the form of an electronic transmission or on paper.
~ WHB is required by law to protect the privacy of its customers. It will keep confidential any and all PHI and will provide customers with a list of duties or practices that protect PHI.
~ WHB will abide by the terms of this notice. WHB reserves the right to make changes to this notice and continue to maintain the confidentiality of all PHI. CUSTOMERS will receive a mailed copy of any changes to this notice within 60 days of making the changes.
~ You have the right to complain to WHB if you believe your rights to privacy have been violated. If you feel your privacy rights have been violated, please mail your complaint to WHB. ~ All complaints will be investigated and you will receive a follow-up call or letter of corrective action plan.
~ For further information about this privacy notice, please contact Vicki D. Jones: 903-758-9904.
~ This notice is effective as of Date of Effectiveness. This date must not be earlier than the date on which the notice is printed or published.
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Signature of Customer Acknowledging Understanding of Supplier Standards Date
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Witness Signature Date