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Medicare Updates Compliance Standards for DME Sales in Practitioners' Offices
CMS Updates Compliance Standards for DME Sales in Practitioners' Offices
The Centers for Medicare and Medicaid Services (CMS) has released Change Request (CR) 6528, impacting guidelines for sleep labs that administer durable medical equipment.
The CR outlines guidelines for DMEPOS that are maintained at a location owned by a physician or non-physician practitioner with a purpose to distribute products to Medicare beneficiaries. After the March 1, 2010, effective date for CR 6528, “Physicians or non-physicians must be enrolled as a DMEPOS provider to distribute nebulizers, orthotics etc, [because] once the inventory previously owned by a DME company is dispensed, the physician or non-physician has become the supplier and is responsible for meeting all regulatory issues associated with billing Medicare Part B for the DMEPOS item,” says Peggy Miller, senior consultant for DME Defender, Houston.
These new guidelines result in significant changes for sleep labs that sell durable medical equipment, according to Miller. “Sleep labs that allowed DME companies to ‘stock’ equipment and supplies (masks) for use during the titration study and mask fitting will now need to enroll as a DMEPOS provider if they wish to continue this practice,” she says. “Two problems stem from that: (1) the sleep lab would be required to bill for the CPAP and/or mask once dispensed but is prohibited by law in providing the equipment; and (2) the lab would not be exempt from becoming accredited under the DMEPOS Accreditation Standards by an accrediting body such as CHAPS or JCAHO and complying with the requirement to purchase a Surety Bond.”
Suppliers involved in these arrangements are commonly referred to as consignment closets or stock/bill arrangements. According to Miller, prior to CR 6528, there was no hard and fast rule for how these consignment closets could operate; however, there were guidelines put out by the Office of Inspector General (OIG) on what was and was not acceptable.
An announcement from the National Supplier Clearinghouse about CR 6528 reads, “Effective March 1, 2010, Medicare will allow enrolled suppliers to maintain inventory at a practice location or a physician or a non-physician practitioner when the following conditions are met:
• The title to the DMEPOS shall be transferred to the enrolled physician or non-physician practitioner's practice at the time the DMEPOS is distributed to the beneficiary.
• The physician or non-physician practitioner's practice shall bill for the DMEPOS supplies and services using their own enrolled DMEPOS billing number.
• All services provided to a Medicare beneficiary concerning fitting or use of the DMEPOS shall be performed by individuals being paid by the physician or non-physician practitioner's practice, not by any other DMEPOS supplier.
• The beneficiary shall be advised that, if they have a problem or questions with the DMEPOS, they should contact the physician or non-physician practitioner's practice, not the DMEPOS supplier who placed the DMEPOS at the physician or non-physician practitioner's practice.”
For more information, suppliers can read the MLN Matters article.
Related articles:
DME MACs Revise Documentation Section of Positive Airway Pressure LCD
The Centers for Medicare and Medicaid Services (CMS) has released Change Request (CR) 6528, impacting guidelines for sleep labs that administer durable medical equipment.
The CR outlines guidelines for DMEPOS that are maintained at a location owned by a physician or non-physician practitioner with a purpose to distribute products to Medicare beneficiaries. After the March 1, 2010, effective date for CR 6528, “Physicians or non-physicians must be enrolled as a DMEPOS provider to distribute nebulizers, orthotics etc, [because] once the inventory previously owned by a DME company is dispensed, the physician or non-physician has become the supplier and is responsible for meeting all regulatory issues associated with billing Medicare Part B for the DMEPOS item,” says Peggy Miller, senior consultant for DME Defender, Houston.
These new guidelines result in significant changes for sleep labs that sell durable medical equipment, according to Miller. “Sleep labs that allowed DME companies to ‘stock’ equipment and supplies (masks) for use during the titration study and mask fitting will now need to enroll as a DMEPOS provider if they wish to continue this practice,” she says. “Two problems stem from that: (1) the sleep lab would be required to bill for the CPAP and/or mask once dispensed but is prohibited by law in providing the equipment; and (2) the lab would not be exempt from becoming accredited under the DMEPOS Accreditation Standards by an accrediting body such as CHAPS or JCAHO and complying with the requirement to purchase a Surety Bond.”
Suppliers involved in these arrangements are commonly referred to as consignment closets or stock/bill arrangements. According to Miller, prior to CR 6528, there was no hard and fast rule for how these consignment closets could operate; however, there were guidelines put out by the Office of Inspector General (OIG) on what was and was not acceptable.
An announcement from the National Supplier Clearinghouse about CR 6528 reads, “Effective March 1, 2010, Medicare will allow enrolled suppliers to maintain inventory at a practice location or a physician or a non-physician practitioner when the following conditions are met:
• The title to the DMEPOS shall be transferred to the enrolled physician or non-physician practitioner's practice at the time the DMEPOS is distributed to the beneficiary.
• The physician or non-physician practitioner's practice shall bill for the DMEPOS supplies and services using their own enrolled DMEPOS billing number.
• All services provided to a Medicare beneficiary concerning fitting or use of the DMEPOS shall be performed by individuals being paid by the physician or non-physician practitioner's practice, not by any other DMEPOS supplier.
• The beneficiary shall be advised that, if they have a problem or questions with the DMEPOS, they should contact the physician or non-physician practitioner's practice, not the DMEPOS supplier who placed the DMEPOS at the physician or non-physician practitioner's practice.”
For more information, suppliers can read the MLN Matters article.
Related articles:
DME MACs Revise Documentation Section of Positive Airway Pressure LCD
Views: 278
Replies to This Discussion
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Permalink Reply by Judy on
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I see this as a GOOD thing. It puts the responsibility for successful CPAP compliance squarely back on the shoulders of the sleep doctor and sleep lab by providing the support, education and advice the patieint SHOULD be getting and from those trained and educated in sleep rather than respiratory w/o proper training in sleep.
Of course, most sleep labs and sleep doctors are independent of the local DME suppliers and it won't make any difference for them. *sigh*
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Permalink Reply by Christine C on
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Okay..I'm confused..All that looks like foreign language to me. Does this mean that I will no longer get supplies from my local DME? I have really hit a brick wall when it comes to my diagnosis and getting education about apnea and the equipment that I use from my doctor as well as my DME. Neither one can seem to tell me what any of the numbers mean either on the data card or from my results. I really dislike living in a small town. We have the population of about 2,500, and I can say that probably half of that is 75 or older. Most of them have used one of this towns 4 doctors for years and years. I really wish that I could find a good sleep doctor, but it is so hard when you live in East Podunk and you rely on the what little bus transportation that we have here (it takes a loop around our town from one end to the other). I have gotten more education and support from this forum than I have from my own doctor. I am so glad that I found you all. I think I would be lost if I didn't have you all to answer some of the questions I had or to be a sounding board to what was on my mind no matter how small it is. ~Thanks~
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This applies to those sleep labs that also provide the CPAP equipment to the patient. There aren't too many such approved sleep labs as compared to the independent local DME suppliers. But for those sleep labs that DO also provide the equipment their sleep doctors are going to HAVE to get off their duff and either provide the support and education themselves, or more likely hire educated staff to provide that support and education to their patients.
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Okay..thanks...I was hoping that it meant that I would get better education from either my DME or my physician. I gues I'm going to have to get more preactive about this
Judy said:This applies to those sleep labs that also provide the CPAP equipment to the patient. There aren't too many such approved sleep labs as compared to the independent local DME suppliers. But for those sleep labs that DO also provide the equipment their sleep doctors are going to HAVE to get off their duff and either provide the support and education themselves, or more likely hire educated staff to provide that support and education to their patients.
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