Medicare Supplier Standards

Medicare has established 31 Supplier Standards that all Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers must adhere to in order to obtain and maintain billing privileges. These standards are detailed in 42 C.F.R. § 424.57(c). Below is a summary of each standard:

1. Compliance with Licensure Requirements: Suppliers must comply with all applicable federal and state licensure and regulatory requirements.

2. Accurate Information: Suppliers must provide complete and accurate information on the DMEPOS supplier application and report any changes within 30 days.

3. Authorized Signature: An authorized individual whose signature is binding must sign the enrollment application for billing privileges.

4. Direct Solicitation Prohibited: Suppliers are prohibited from contacting Medicare beneficiaries by telephone regarding the furnishing of a Medicare-covered item unless specific conditions are met.

5. Delivery and Instruction: Suppliers must deliver items directly to beneficiaries and provide necessary instructions on their use.

6. Beneficiary Complaints: Suppliers must answer questions and respond to complaints from beneficiaries regarding Medicare-covered items.

7. Maintenance and Replacement: Suppliers must maintain and replace at no charge or repair directly, or through a service contract with another company, Medicare-covered items rented to beneficiaries.

8. Return Policy: Suppliers must accept returns of substandard or unsuitable items from beneficiaries.

9. Disclosure of Standards: Suppliers must disclose these standards to each beneficiary to whom they supply a Medicare-covered item.

10. Ownership Disclosure: Suppliers must disclose any person having ownership, financial, or control interest in the supplier.

11. Prohibition on Sharing a Practice Location: Suppliers are prohibited from sharing a practice location with other Medicare providers and suppliers.

12. Complaint Resolution Protocol: Suppliers must have a protocol to address beneficiary complaints related to these standards and maintain records of such complaints.

13. Complaint Records: Suppliers must maintain records of all written and oral beneficiary complaints, including telephone complaints.

14. Provision of Information to CMS: Suppliers must provide CMS with any information required by the Medicare statute and regulations.

15. Accreditation: All suppliers must be accredited by a CMS-approved accreditation organization to receive and retain a supplier billing number.

16. Notification of New Locations: Suppliers must notify their accreditation organization when opening a new DMEPOS location.

17. Separate Accreditation for Each Location: All supplier locations, whether owned or subcontracted, must meet the DMEPOS quality standards and be separately accredited to bill Medicare.

18. Disclosure of Products and Services: Suppliers must disclose upon enrollment all products and services, including new product lines for which they are seeking accreditation.

19. Surety Bond Requirement: Suppliers must meet the surety bond requirements specified in 42 C.F.R. § 424.57(d).

20. Prohibition on Reassignment of Supplier Number: Suppliers must not convey or reassign a supplier number.

21. Maintenance of a Physical Facility: Suppliers must maintain a physical facility on an appropriate site with a visible sign and posted hours of operation.

22. On-Site Inspections: Suppliers must permit CMS or its agents to conduct on-site inspections to ascertain compliance with these standards.

23. Primary Business Telephone: Suppliers 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.

24. Comprehensive Liability Insurance: Suppliers must have a comprehensive liability insurance policy in the amount of at least $300,000.

25. Prohibition on Contracting with Excluded Entities: Suppliers 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.

26. Advising Beneficiaries on Rent or Purchase Options: Suppliers must advise beneficiaries that they may rent or purchase inexpensive or routinely purchased durable medical equipment and inform them of the purchase option for capped rental equipment.

27. Warranty Coverage: Suppliers must notify beneficiaries of warranty coverage and honor all warranties under applicable state law.

28. Beneficiary Instruction: Suppliers must instruct beneficiaries on the use of Medicare-covered items and maintain proof of delivery and beneficiary instruction.

29. Beneficiary Contact Information: Suppliers must furnish information to beneficiaries at the time of delivery on how they can contact the supplier by telephone.

30. Prohibition on Exclusive Use of Certain Communication Devices: The exclusive use of a beeper, answering machine, answering service, or cell phone during posted business hours is prohibited.

31. Hours of Operation: Suppliers must remain open to the public for a minimum of 30 hours per week, with certain exceptions for physicians and other specified practitioners.

For a detailed description of each standard, please refer to the official documentation provided by the Centers for Medicare & Medicaid Services (CMS).