Form Cms-855s - Medicare Enrollment Application - Durable Medical Equipment, Prosthetics, Orthotics, And Supplies (Dmepos) Suppliers Page 2
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27Form Approved
DEPARTMENT OF HEALTH AND HUMAN SERVICES
OMB No. 0938-1056
CENTERS FOR MEDICARE & MEDICAID SERVICES
Expires: 05/19
DMEPOS SUPPLIER STANDARDS FOR MEDICARE ENROLLMENT
Below is an abbreviated summary of the standards every Medicare DMEPOS supplier must meet in order to obtain
and retain their billing privileges. These standards, in their entirety, including the surety bond provisions, are listed
in 42 C.F.R. section 424.57(c) and (d) and can be found at
DMEPOSSupplierStandards.asp#topofpage.
1. A supplier must be in compliance with all applicable
14. A supplier must maintain and replace at no charge or
federal and state licensure and regulatory
repair cost either directly or through a service contract
requirements.
with another company, any Medicare-covered items it
has rented to beneficiaries.
2. A supplier must provide complete and accurate
information on the DMEPOS supplier application. Any
15. A supplier must accept returns of substandard (less
changes to this information must be reported to the
than full quality for the particular item) or unsuitable
National Supplier Clearinghouse within 30 days.
items (inappropriate for the beneficiary at the time it
was fitted and rented or sold) from beneficiaries.
3. A supplier must have an authorized individual whose
signature is binding sign the enrollment application for
16. A supplier must disclose these standards to each
billing privileges.
beneficiary it supplies a Medicare-covered item.
4. A supplier must fill orders from its own inventory
17. A supplier must disclose any person having ownership,
or contract with other companies for the purchase
financial or control interest in the supplier.
of items necessary to fill orders. A supplier cannot
18. A supplier must not convey or reassign a supplier
contract with any entity that is currently excluded from
number; i.e., the supplier may not sell or allow another
the Medicare program, any state health care programs,
entity to use its Medicare billing number.
or any other federal procurement or non-procurement
19. A supplier must have a complaint resolution protocol
programs.
established to address beneficiary complaints that
5. A supplier must advise beneficiaries that they may rent
relate to these standards. A record of these complaints
or purchase inexpensive or routinely purchased durable
must be maintained at the physical facility.
medical equipment, and of the purchase option for
20. Complaint records must include: the name, address,
capped rental equipment.
telephone number and health insurance claim number
6. A supplier must notify beneficiaries of warranty
of the beneficiary, a summary of the complaint, and
coverage and honor all warranties under applicable
any actions taken to resolve it.
state law, and repair or replace free of charge
21. A supplier must agree to furnish CMS any information
Medicare covered items that are under warranty.
required by the Medicare statute and regulations.
7. A supplier must maintain a physical facility on an
22. A supplier must be accredited by a CMS-approved
appropriate site and must maintain a visible sign
accreditation organization in order to receive and
with posted hours of operation. The location must
retain a supplier billing number. The accreditation must
be accessible to the public and staffed during posted
indicate the specific products and services for which
hours of business. The location must be at least 200
the supplier is accredited in order for the supplier to
square feet and contain space for storing records.
receive payment for those specific products and services
8. A supplier must permit CMS or its agents to conduct
(unless an exception applies).
on-site inspections to ascertain the supplier’s
23. A supplier must notify their accreditation organization
compliance with these standards.
when a new DMEPOS location is opened.
9. A supplier must maintain a primary business telephone
24. All supplier locations, whether owned or
listed under the name of the business in a local
subcontracted, must meet the DMEPOS quality
directory or a toll free number available through
standards and be separately accredited in order to bill
directory assistance. The exclusive use of a beeper,
Medicare.
answering machine, answering service or cell phone
25. A supplier must disclose upon enrollment all products
during posted business hours is prohibited.
and services, including the addition of new product
10. A supplier must have comprehensive liability insurance
lines for which they are seeking accreditation.
in the amount of at least $300,000 that covers both
26. A supplier must meet the surety bond requirements
the supplier’s place of business and all customers and
specified in 42 C.F.R. section 424.57(d) (unless an
employees of the supplier. If the supplier manufactures
exception applies).
its own items this insurance must also cover product
27. A supplier must obtain oxygen from a state-licensed
liability and completed operations.
oxygen supplier.
11. A supplier is prohibited from direct solicitation to
28. A supplier must maintain ordering and referring
Medicare beneficiaries. For complete details on this
documentation consistent with provisions found in 42
prohibition see 42 C.F.R. section 424.57(c)(11).
C.F.R. section 424.516(f).
12. A supplier is responsible for delivery of and must
29. A supplier is prohibited from sharing a practice location
instruct beneficiaries on the use of Medicare covered
with other Medicare providers and suppliers.
items, and maintain proof of delivery and beneficiary
30. A supplier must remain open to the public for a
instruction.
minimum of 30 hours per week except physicians (as
13. A supplier must answer questions and respond
defined in section 1848(j) (3) of the Act), physical and
to complaints of beneficiaries and maintain
occupational therapists or DMEPOS suppliers working
documentation of such contacts.
with custom made orthotics and prosthetics.
CMS-855S (05/16)
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