Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) include any medical equipment that gives therapeutic benefits to patients with a particular medical illness and/or need. In order to become a registered supplier of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), you must submit an application and supporting documents (such as a surety bond) to the Centers for Medicare & Medicaid Services (CMS).
This guide will explain who needs to go through this process in order to supply DMEPOS equipment, how to apply, and how to get the required surety bond.
In November 2006, CMS approved 10 national accreditation organizations that accredit suppliers of DMEPOS. The new approval means the 10 accredited organizations meet new and strict policy standards under Medicare part B.
In order for suppliers to enroll or to keep Medicare billing privileges, every Medicare DMEPOS supplier must now abide by the Medicare program’s supplier standards. Equipment includes therapeutic shoes, durable medical equipment, medical supplies, transfusion medicine, prosthetics and orthotics, parenteral/enteral nutrition, home dialysis supplies and equipment, and prosthetic devices.
National Provider Identification
Each location that a supplier manages requires a National Provider Identification. This is a 10-digit identification number unique to each health care provider in the United States issued by the Centers for Medicare & Medicaid Services. A NPI can be assigned by the CMS within 10 days of application only if the application is free of errors.
DMEPOS Equipment Guidelines
Medical Equipment falls under the DMEPOS category if it meets these requirements:
- Mostly used to serve a medical purpose
- Not useful in the absence of an illness or injury
- Ordered or prescribed by a physician
- Can be reused and used repeatedly
- Have the ability to be used in the home
More specifically, medical equipment includes but is not limited to: wheelchairs, hospital beds, monitors, oxygen, lifts, nebulizers, kidney machines, canes, crutches, walkers, etc. A client that receives medical supplies such as these from a registered supplier will be covered for durable medical equipment, equipment maintenance and repairs, replacements of equipment, as well as rental equipment instead of having to purchase it new.
However, there are certain medical professionals who are exempt from these accreditation standards. On March 23, 2010, HR 3590 was signed into Public Law no: 111-148, amending Title XVII of Social Security Act. Now, a pharmacy is exempt from accreditation standards if the pharmacy meets all of the following criteria.
- Total DMEPOS billings for the pharmacy is less than 5% of all pharmacy sales
- The pharmacy has been enrolled as a DMEPOS supplier and has had a provider number for the past 5 years
- No unfavorable action has been taken against the pharmacy for the past 5 years
- The pharmacy submits an attestation to the CMS, and is determined by the CMS that the pharmacy meets the first 3 criteria listed above
- During the course of a random audit, the pharmacy agrees to submit requested materials
DMEPOS Enrollment Application
- Obtain DMEPOS accreditation. You must obtain DMEPOS accreditation from a CMS-approved organization. This organization will verify that your business meets the required DMEPOS Quality Standards and conduct periodic, unannounced site visits. You can find a list of CMS-approved accreditation organizations on the CMS website.
- Enroll in the Medicare program. You can enroll in the Medicare program as a DMEPOS supplier through the CMS website. You will need to provide your business information, contact information, and financial information. You will also need to pay a one-time application fee.
- Post a surety bond. You must post a surety bond to your enrollment contractor. This bond guarantees that you will pay any claims that Medicare denies or that are determined to be fraudulent. The amount of the bond is determined by the Medicare Administrative Contractor (MAC) in your area.
- Obtain a National Provider Identifier (NPI). You must obtain a National Provider Identifier (NPI) for each practice location. You can obtain an NPI from the Centers for Medicare & Medicaid Services (CMS).
- Complete the Enrollment Application and Electronic Funds Transfer Authorization Agreement CMS-588. You must complete the Enrollment Application and Electronic Funds Transfer Authorization Agreement CMS-588. This application provides information about your business and your Medicare enrollment.
- Pay the Medicare Application Fee. You must pay a one-time application fee to enroll in the Medicare program. The amount of the fee is determined by the MAC in your area.
- Work With Your Enrollment Contractor. Once you have completed all of the required steps, you will work with your enrollment contractor to finalize your enrollment. Your enrollment contractor will provide you with instructions on how to submit claims to Medicare.
An application to enroll as a Medicare Supplier can be found on the CMS website. The application can be filled out electronically and then submitted by hard copy since a handwritten signature is required. Fortunately, filling out the application online provides fewer chances for mistakes, questions, and delays when the application is processed. It is a good idea to keep a copy of the signed application for personal records. After the application is filled out, it must be signed by the applicant before it is mailed. If this step is not completed, the application will not be reviewed. The completed and signed application along with any supporting documents must then be mailed to the particular Medicare-fee-for-service contractor. Additional forms including the CMS-588 and CMS-460 forms can be found on the CMS website.
The application fee is $560 which allows the Secretary of State to cover the cost of screening for the application. This fee is for 2017, and will vary from year to year. Applications that are not paid for will not be processed.
DMEPOS Supplier Surety Bond
This type of surety bond can be referred to by different titles including Medicare Surety Bond, DMEPOS Surety Bond, Medicaid Surety Bond, Medicaid DMEPOS, or Medicare DMEPOS.
The Centers for Medicare and Medicaid Services (CMS) requires a surety bond in order to control and to stop medical billing fraud. This bonding requirement was established in 2009 when medical billing fraud became an issue in the healthcare industry. A DMEPOS supplier must file a $50,000 surety bond in order to bill Medicare. Also, if there is a change of ownership within the business, a surety bond must be obtained in order to move to a new business location. Since these bonds are required by the CMS, the bonds are referred to as both a Medicare Surety Bond and a Medicaid Surety Bond. These provider bonds are alike, although they are not issued in the same form.
A Medicare or Medicaid surety bond protects clients from fraud or malpractice by bonded DMEPOS physicians or medical professionals. The bond guarantees all claims filed to Medicare are legal and legitimate. CMS is financially assured by this bond that any potential claims will be resolved by the surety company. If there is a legitimate claim filed against the bond, the surety company will reimburse the client who filed the claim. The bonded supplier or provider would then be responsible to pay the surety company back for the claim.
Surety Bond Cost
Just like any other surety bond, there are many factors that influence the cost of a Medicare bond. The bond amount, the credit score of the applicant, the surety company that ensures the bond, and the type of bond factor into the bond cost (also known as the bond premium). For each location the DMEPOS supplier manages, a National Provider Identifier (NPI) must be covered with a $50,000 surety bond. For example, if a DMEPOS supplier manages 2 NPI locations, the supplier would need a $100,000 surety bond. Each DMEPOS location needs to be bonded.
Apply for Your Medicare DMEPOS Bond
Aiming to promote success for clients, Surety1 works to achieve the lowest possible price for bonds. Visit the application page to apply for a DMEPOS surety bond. For any questions, our friendly agents will be happy to assist the client in any way. It is free to apply and payments can either be made online or over the phone.
1. Complete an online application.
2. One of our surety experts will call and email you with the firm quote and an agreement to sign.
3. Provide payment and your signed agreement, then you will receive your bond!
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