MEDICARE SUPPLIER STANDARDS

Below wehave posted the Medicare Supplier Standards. Please note that this is anabbreviated version of the supplier standards every Medicare supplier must meetin order to obtain and retain its billing privileges. These standards, in theirentirety, are listed in 42 C.F.R. 424.57(c).

  • 1.     A supplier must be in compliance with all applicable Federal and State     licensure and regulatory requirements and cannot contract with an     individual or entity to provide licensed services.
  • 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. This     standard requires that the location is accessible to the public and     staffed during posted hours of business. The location must be at least 200     square feet and contain space for storing records.
  • 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, answering service, or cell phone during posted business hours 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.
  • 11.     A supplier must agree not to initiate telephone contact with     beneficiaries, with a few exceptions allowed. This standard prohibits     suppliers from contacting a Medicare beneficiary based on a physician’s     oral order unless an exception applies.
  • 12.     A supplier is responsible for delivery and must instruct beneficiaries on     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 an 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 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 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 of     those specific products and services (except for certain exempt     pharmaceuticals).
  • 23.     All suppliers must notify their accreditation organization when a new     DMEPOS location is opened.
  • 24.     All supplier locations, whether owned or subcontracted, must meet the     DMEPOS quality standards and be separately accredited in order to bill     Medicare.
  • 25.     All suppliers must disclose upon enrollment all products and services,     including the addition of new product lines for which they are seeking     accreditation.
  • 26.     All suppliers must meet the surety bond requirements specified in 42     C.F.R. 424.57(c).
  • 27.     A supplier must obtain oxygen from a state-licensed oxygen supplier.
  • 28.     A supplier must maintain ordering and referring documentation consistent     with provisions found in 42 C.F.R. 424.516(f).
  • 29.     DMEPOS suppliers are prohibited from sharing a practice location with     certain other Medicare providers and suppliers.
  • 30.     DMEPOS suppliers must remain open to the public for a minimum of 30 hours     per week with certain exceptions.