CMS Issues Final Rule on Supplier Standards

BALTIMORE — The Centers for Medicare and Medicaid Services
issued a final rule today on Medicare enrollment standards for
DMEPOS providers.

Based on a proposed rule
issued in 2008, the new regulation adds several new standards
and modifies existing standards that providers must meet before
being able to furnish home medical equipment to Medicare
beneficiaries. According to a statement from CMS, “These new and
stronger standards will help to reduce fraud in Medicare and
provide beneficiaries with additional assurance that they are being
served by legitimate suppliers who meet Medicare’s standards.”

“We know the majority of medical equipment suppliers and health
care 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
Peter Budetti, CMS deputy administrator for program integrity, in
the statement. “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.”

According to CMS, the final rule will:

• Require HME providers to obtain oxygen from a state-licensed
  oxygen supplier (which applies only in states that require oxygen
  licensure).

• Require HME providers to remain open to the public for at least
  30 hours per week, with exceptions for physicians or licensed
  non-physician practitioners furnishing services to their own
  patients as part of their professional service, and HME providers
  working with custom made orthotics and prosthetics.

• Ensure that HME providers continue to maintain ordering and
  referring documentation from physicians or non-physician
  practitioners.

• Prohibit HME providers 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 providers must meet to
establish and maintain billing privileges in the Medicare program.
Specifically, this final rule would revise current standards as
follows:

• Ensure that the DMEPOS supplier maintains a physical facility on
  an appropriate site that must:

  • Measure at least 200 square feet, except for state-licensed
    orthotic and prosthetic personnel providing custom fabricated
    orthotics or prosthetics in private practice;
  • Be in a location that is accessible to the public, Medicare
    beneficiaries, CMS, the National Supplier Clearinghouse (NSC) and
    its agents and not in a gated community or other area where access
    is restricted;
  • Be accessible and staffed during posted hours of
    operation;
  • Maintain a permanent visible sign in plain view and post hours
    of operation; and
  • Be in a location that contains space for storing business
    records, including the supplier’s delivery, maintenance, and
    beneficiary communication records.

• Prohibit the use of cell phones, beeper numbers and pagers as a
  primary business telephone number. In addition, answering machines
  and answering services may not be used exclusively as a supplier’s
  primary telephone number during posted business hours.

• Expand the prohibition on HME provider telephone solicitation of
  a Medicare beneficiary to also include in-person contacts, e-mails,
  instant messaging, and Internet coercive advertising.

A copy of the final rule is posted on the Federal
Register site at: http://www.ofr.gov/OFRUpload/OFRData/2010-21354_PI.pdf

And will be posted at: http://www.cms.gov/MedicareProviderSupEnroll/09_ProviderEnrollmentRegulation.asp#TopOfPage

The current supplier enrollment standards can be found on the
NSC website at http://www.palmettogba.com/nsc.

Check HomeCare Monday and www.HomeCareMag.com for further information and
details.