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Medicare DMEPOS Supplier Standards

Note: This is an abbreviated version of the supplier standards every Medicare DMEPOS supplier must meet in order to obtain and retain their billing privileges. These standards, in their entirety, are listed in 42 C.F.R. 424.57.

Medicare DMEPOS Supplier Standards

  1. A supplier must be in compliance with all applicable Federal and State licensure and regulatory requirements.

  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. A supplier must have an authorized individual (whose signature is binding) sign the enrollment application for billing privileges.

  4. A supplier must fill orders from its own inventory or contract with other companies for the purchase of items necessary to fill orders. A supplier may not contract with any entity that is currently excluded from the Medicare program, any State health care programs, or 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 and must maintain a visible sign with posted hours of operation. The location must be 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.

  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 is prohibited from direct solicitation to Medicare beneficiaries. For complete details on this prohibition, see 42 CFR § 424.57 (11).

  12. A supplier is responsible for the delivery of and must instruct beneficiaries on the use of Medicare covered items and maintain proof of delivery and beneficiary instruction.

  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 cost either directly or through a service contract with another company any 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 standards to each beneficiary it supplies a Medicare-covered item.

  17. A supplier must disclose any person having 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 regulations.

  22. All suppliers must be accredited by a CMS-approved accreditation organization 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 for 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 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. A supplier must meet the surety bond requirements specified in 42 CFR § 424.57 (d).

  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 CFR § 424.516(f).

  29. A supplier is prohibited from sharing a practice location with other Medicare providers and suppliers.

  30. A supplier must remain open to the public for a minimum of 30 hours per week except physicians (as defined in section 1848(j) (3) of the Act) or physical and occupational therapists or a DMEPOS supplier working with custom made orthotics and prosthetics.

DMEPOS suppliers have the option to disclose the following statement to satisfy the requirement outlined in Supplier Standard 16 in lieu of providing a copy of the standards to the beneficiary.

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The products and/or services provided to you by (supplier legal business name or DBA) are subject to the supplier standards contained in the Federal regulations shown at 42 Code of Federal Regulations Section 424.57(c). These standards concern business professional and operational matters (e.g. honoring warranties and hours of operation). The full text of these standards can be obtained at http://www.ecfr.gov. Upon request we will furnish you a written copy of the standards.

Patient Bill of Rights and Responsibilities

You have the right to:

  • Be treated with dignity, courtesy and respect and have relationships with company providers that are based on honesty and ethical standards of conduct.

  • Reasonable coordination and continuity of services and timely response when home care equipment is needed or requested and to be informed in a timely manner of impending discharge.

  • Be fully informed upon admission of the company’s policies, procedures, ownership or control of the local facility and the process for receiving, reviewing and resolving your complaints or concerns.

  • Receive complete explanations of charges for services and equipment, including eligibility for third-party reimbursement and an explanation of all forms you are requested to sign.

  • Receive quality equipment and services that meet or exceed professional and industry standards regardless of race, religion, political belief, sex, social status, age or disability and to receive instructions on safe and effective operation of equipment and your responsibilities regarding equipment and services, including pain and pain management modalities.

  • Confidentiality of all your records (except as otherwise provided for by law or third-party payer contracts) and to review and even challenge those records and to have your records corrected for accuracy.

  • Be advised of any change in the plan of care before the change is made.

  • Participate in the planning of the care and in planning changes in the care, and to be advised that you have the right to do so.

  • Have an advance directive for medical care, such as a Living will or the designation of a surrogate decision maker, respected to the extent provided by the law.

  • Participate in the consideration of ethical issues that arise in your care.

  • Accept or refuse medical treatment while competent and to make decisions about care/services to be received should you lose competency.

  • Be advised of the telephone number and hours of operation of the state’s Insurance Fraud “Hot Line.” The hours are 9 AM to 5 PM and the number is (800) 927-HELP.

  • Be advised of the telephone number for Medicare Complaints 800-633-4227.

  • Be advised of the telephone number and hours of operation of the accrediting organization, BOC International. The hours are Monday Friday 8 AM to 5 PM and the telephone number is 877-776-2200

Patient Bill of Rights and Responsibilities

You have the responsibility to:

  • Adhere to the plan of treatment or service established by their physician.

  • Participate in the development of an effective plan of care which will involve the management of pain, if appropriate.

  • Provide medical and personal information necessary to plan and provide services.

  • Be available at the time deliveries are made and to allow company’s representative to enter their residence at reasonable times to repair or exchange equipment or to provide care.

  • Notify the company if he/she is going to be unavailable.

  • Treat company personnel with respect and dignity without discrimination.

  • Provide a safe environment for staff to provide care and services.

  • Care for and safely use equipment, according to instructions provided, for the purpose it was prescribed and only for/on the client for whom it was prescribed. Monitor the quantity of oxygen, nutritional products, medications and supplies in their homes and reorder as required to assure timely delivery of the required items.

  • Protect equipment from fire, water, theft or other damage. The client agrees not to transfer or allow his/her equipment to be used by any other person without prior written consent of the company and further agrees not to modify or attempt to make repairs of any kind to the equipment.

  • Except where contrary to federal or state law, the client is responsible for equipment rental and sale charges which the client’s insurance company or companies does not pay. The client is responsible for settlement in full of his/her accounts.

  • The company should be notified of any changes in the client’s physical condition, physician’s prescription or insurance coverage. Notify the company immediately of any address or telephone changes whether temporary or permanent.

  • Contact our company if you acquire an infectious disease during the time you are receiving services and/or care of our company, except where exempted by law.

Return Policy

If item was substandard, unsuitable or inappropriate at the time of delivery it can be returned unconditionally.
Purchased or rented equipment that no longer meets the needs of the client may be returned to the company within thirty (30) days from start of service, provided the equipment:

 

Has been cared for appropriately and used for the purpose it was prescribed and only for the client for whom it was prescribed

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Has not been modified or repaired by someone other than an authorized representative 

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Is not a product intimate in nature

Return Policy

Warranty Policy

All equipment purchased, rented or leased as “new” from the company will be in good working order according to manufacturer’s specifications. All new equipment is warranted by the facility for a period of thirty (30) days from the date of purchase or home delivery. The company will assist the client, as necessary and appropriate, to facilitate the reimbursement or equipment replacement pursuant to all equipment manufacturers’  warranties. The company will provide, or arrange for, loaner equipment equivalent to the original equipment during any repair period except for orthotics and prosthetics.

Warranty Policy

Complaint Policy

All customers have the right to lodge complaints without fear of discrimination or reprisal and to know the disposition of complaints. The organization has the responsibility to respond to those complaints promptly and to resolve complaints whenever possible to the satisfaction of the individual. All complaints shall be investigated within five (5) days and within fourteen (14) days provide written resolution of the investigation to the beneficiary. Should you wish to lodge a complaint or to praise us about our products or services, see any staff member or call:

 

Complaints please call us at (925) 930-7801

Complaint Policy

 

If your complaint is not resolved by calling us, you may call one of the following numbers:

 

800.927.HELP (State Hotline)
877.776.2200 (Our Accrediting Organization BOC)
1-800-Medicare (800-633-4227) Medicare

Patient Privacy

We are committed to preserving the privacy of your personal health information. In fact, we are required by law to protect the privacy of your  medical information and to provide you with Notice describing:

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HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. 

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We use health information about you for treatment, to obtain payment for treatment, for administrative purposes, and to evaluate the quality

of care that you receive. We may be required or permitted by certain laws to use and disclose your medical information for other purposes without your consent or authorization. As our patient, you have important rights relating to inspecting and copying your medical information that we maintain, amending or correcting that information, obtaining an accounting of our disclosures of your medical information, requesting that we communicate with you confidentially, requesting that we restrict certain uses and disclosures of your health information, and complaining if you think your rights have been violated.

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We have available a detailed Notice of Privacy Practices which fully explains your rights and our obligations under the law. We may revise our Notice from time to time. The effective date at the top right hand side of this page indicates the date of the most current Notice in effect. You have the right to receive a copy of our most current Notice in effect. If you have not yet reserved a copy of our current Notice, please ask at the front desk and we will provide you with a copy. 

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If you have any questions, concerns or complaints about the Notice or your medical information,

please contact our office at (925) 930-7801.

Patient Privacy
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