CMS has imposed a number of new requirements on suppliers of Durable Medical Equipment, Prosthetics, Orthotics and Supplies.  

Surety Bonds

  • Beginning May 4, 2009, a $50,000 surety bond is required of any DMEPOS supplier that attempts to enroll in Medicare, changes ownership, or is required to revalidate its enrollment data or reenroll.  
  • As of October 2, 2009, all currently-enrolled suppliers must satisfy the surety bond requirement.  
  • The surety bond must be (1) furnished to the National Supplier Clearinghouse (the Medicare contractor that handles DMEPOS enrollment) and (2) issued by an approved surety.
  • Separate bonds are required for each NPI under which Medicare is billed.
  • A supplier that adds a new location to an existing NPI must obtain a separate bond for the location or amend its existing bond to add the location.
  • CMS may require a higher bond from “high-risk” suppliers.  
  • The rule includes exceptions to the surety bond requirement for (1) physicians and other practitioners who provide DME only to their own patients as part of their professional services, and (2) licensed orthotic and prosthetic personnel in private practice who provide custom POS.  

Accreditation  

Existing DMEPOS suppliers must be accredited by a CMS-approved organization by September 30, 2009. Specific categories of practitioners (such as physicians) are exempt from the accreditation requirement.  

CPAP Coverage Requirement  

On March 13, 2008, CMS issued a National Coverage determination that extended Medicare coverage of continuous positive airway pressure (CPAP) devices to beneficiaries who were diagnosed with obstructive sleep apnea by means of certain home sleep tests. (Prior to the 2008 NCD, the diagnosis needed to be made using attended facility-based polysomnography.)  

Home sleep testing occurs in patient homes, which obviously are less regulated environments than institutional sleep labs. Therefore, CMS adopted a new regulation intended to curb abuse. Effective January 1, 2009, a CPAP device is not covered if the supplier of the device or the supplier’s affiliate either directly or indirectly administered or interpreted the unattended out-of-facility sleep test used to diagnose obstructive sleep apnea.