On August 26, 2010, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that clarifies, expands and adds to the existing Medicare enrollment requirements for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers. The main purpose of the final rule is to provide further protections for Medicare and its beneficiaries from potentially fraudulent DMEPOS suppliers.

The final rule sets forth the following requirements for DMEPOS suppliers:

  • requires DMEPOS suppliers to obtain oxygen from a state-licensed oxygen supplier; this rule only applies in states that require oxygen suppliers to be licensed
  • requires DMEPOS suppliers to remain open to the public for at least 30 hours a week, with exceptions for (i) physicians or licensed non-physician practitioners furnishing services to their own patients as part of their professional service and (ii) DMEPOS suppliers working with custom-made orthotics and prosthetics
  • ensures that DMEPOS suppliers continue to maintain ordering and referring documentation from physicians or non-physician practitioners
  • prohibits DMEPOS suppliers from sharing a practice location with certain other Medicare providers and suppliers subject to certain exceptions
  • prohibits DMEPOS suppliers from contracting with other individuals or entities to perform DMEPOS licensed services, with certain exceptions

The final rule also clarifies and expands the existing enrollment requirements that DMEPOS suppliers must meet to establish and maintain Medicare billing privileges. The final rule revises current standards as follows:

  • DMEPOS suppliers are required to maintain a physical facility on an appropriate site that must:
    • measure at least 200 square feet, except for state-licensed orthotic and prosthetic personnel providing customized, fabricated orthotics or prosthetics in private practice
    • be located in an area that is accessible to CMS, the National Supplier Clearinghouse (NSC) and its agents, Medicare beneficiaries and the public, and may not be located 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
    • be in a location that contains space for storing business records, including the DMEPOS supplier’s delivery, maintenance, and beneficiary communication records
  • DMEPOS suppliers are prohibited from using cell phones, beepers and pagers as primary business telephone numbers. In addition, answering machines and answering services may not be used exclusively as a supplier’s primary telephone number during posted business hours.
  • The rule expands the prohibition on a DMEPOS supplier’s telephone solicitation of a Medicare beneficiary to also include in-person contacts, emails, instant messaging and internet coercive advertising.

These regulations are effective on September 27, 2010.