Certain healthcare providers are exempt from the DMEPOS Accreditation and Surety bond requirements of participating with medicare as a DMEPOS supplier. These exemptions apply to professional services provider who supply DMEPOS products to their patients, and only to their patients, as part of their service.
nCred has assisted many exempt providers with DME enrollment, and can help your practice make the enrollment process easy. Give us a call today or request request additional information from our website.
Below is the fact sheet published by Medicare with full details of the exemptions.
ORTHOTICS AND SUPPLIES (DMEPOS) ACCREDITATION
FACT SHEET
The MIPPA, section 154(b), added a new subparagraph (F). This subparagraph states that
eligible professionals and other persons (defined below) are exempt from meeting the
September 30, 2009 accreditation deadline unless CMS determines that the quality
standards are specifically designed to apply to such professionals and persons. CMS will
work in collaboration with the medical and professional groups to develop specific quality
standards. Those providers that were accredited prior to the enactment of MIPPA will not
have to undergo a re-accreditation process.
The eligible professionals (as defined in section 1848(k)(3)(B)) include the following
practitioners:
- Physicians (as defined in section 1861(r) of the Act),
- Physical Therapists,
- Occupational Therapists,
- Qualified Speech-Language Pathologists,
- Physician Assistants,
- Nurse Practitioners,
- Clinical Nurse Specialists,
- Certified Registered Nurse Anesthetists,
- Certified Nurse-Midwives,
- Clinical Social Workers,
- Clinical Psychologists,
- Registered Dietitians, and
- Nutritional professionals
Additionally, section 154(b) of MIPPA allows the Secretary to specify “other persons” that
are exempt from meeting the accreditation deadline unless CMS determines that the quality standards are specifically designed to apply to such other persons. At this time, “such other persons” are only defined as the following practitioners:
- Orthotists,
- Prosthetists,
- Opticians, and
- Audiologists
DMEPOS Accreditation
In order to enroll or maintain Medicare billing privileges, all DMEPOS suppliers (except for exempted professionals and other persons as specified by the Medicare Improvement for Patients and Providers Act of 2008) must comply with the Medicare program’s supplier standards (found at 42 CFR §424.57 (c)) and quality standards to become accredited. The accreditation requirement applies to suppliers of durable medical equipment, medical supplies, home dialysis supplies and equipment, therapeutic shoes, parenteral/enteral nutrition, transfusion medicine and prosthetic devices, and prosthetics and orthotics.
On March 23, 2010, the President signed HR 3590 into Public Law no: 111-148, which amends title XVII of the Social Security Act to exempt a pharmacy from accreditation if it meets all of the following criteria.
- the total billings by the pharmacy for DMEPOS are less than 5 percent of total pharmacy sales;
- the pharmacy has been enrolled as a supplier of durable medical equipment, prosthetics, orthotics and suppliers, as has been issued a provider number for at least 5 years;
- no final adverse action has been imposed on the pharmacy in the past 5 years;
- the pharmacy submits an attestation, as determined by CMS, that the pharmacy meets the first three criteria;
- the pharmacy agrees to submit materials as requested during the course of an audit conducted on a random sample of pharmacies selected annually.
Further information on the DMEPOS accreditation requirements along with a list of the accreditation organizations and the guidance regarding the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) for DMEPOS suppliers can be found on the Downloads section below.
DMEPOS Surety Bond
The Centers for Medicare & Medicaid Services (CMS) published a final rule titled, “Medicare Program: Surety Bond Requirement for Suppliers of Durable Medical equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)” in the Federal Register on January 2, 2009. This final rule implemented Section 4312(a) of the Balanced Budget Act of 1997 and requires certain DMEPOS suppliers to obtain and maintain surety bond on continuing basis. Section 4312(b) requires that a surety bond be in amount of not be less than $50,000.
Enrolled DMEPOS suppliers, subject to the bonding requirement, are required to obtain and submit $50,000 bond for each National Provider Identifier (NPI) by October 2, 2009 to the National Supplier Clearinghouse (NSC). Since DMEPOS suppliers must obtain an NPI by practice location, except for sole proprietorships. For example, an organizational DMEPOS supplier with 20 practice locations would be required to secure a $1 million surety bond.
DMEPOS suppliers exempt from bonding requirement: (1) Government-owned suppliers that have provided CMS with a comparable surety bond under state law. The surety bond shall state that CMS is an obligee and cover obligations concerning claims, (2) State-licensed orthotic and prosthetic personnel in private practice making custom made orthotics and prosthetics if the business is solely-owned and operated by said personnel and is billing only for orthotic and prosthetics, and supplies, (3) Physicians and non-physician practitioners if the DMEPOS items are furnished only to his or her patients as part of his or her professional service, and (4) Physical and occupational therapists if: (1) the business is solely-owned and operated by the therapist, and (2) if the DMEPOS items are furnished only to his or her patients as part of his or her professional service.
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CLICK HERE for additional information regarding DMEPOS accreditation
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When submitting your DMEPOS surety bond to the National Supplier Clearinghouse (NSC), you are required to submit sections 1, 2A1, 12, and either 15 (if you are the authorized official) or 16 (if you are the delegated official) of the Medicare enrollment application (CMS-855S). By submitting the required sections of the CMS-855S, you will help to ensure that NSC is able to correctly associate your DMEPOS surety bond to your enrollment record.
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If your pharmacy is enrolled as a DMEPOS supplier with the NSC and bills the DME MAC (formerly a DMERC) for non-accredited products, including Epoetin, immunosuppressive drugs, infusion drugs, nebulizer drugs, or oral anticancer drugs, you are required to have a surety bond.
Note: The DMEPOS Surety Bond final rule did not establish an exception to the bonding requirement for pharmacies. Accordingly, pharmacies continuing to participate in the Medicare program as a DMEPOS supplier must have a surety bond. Any supplier enrolled with the NSC is considered a DMEPOS supplier.
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nCred provides a wide range of services to healthcare providers. We work with Physicians, Chiropractors, Mid-Level providers, Therapists, Mental Health Providers, Nutritional Providers, DME companies, and other healthcare organizations. Browse our website for more information and request a service proposal by completing our information form on our website or give us a call at 423.443.4525 Option#2.
