A Rundown of DMEPOS Supplier Standards for CMS

Since the majority of your DMEPOS orders are from Medicare recipients, maintaining compliance with the Centers for Medicare and Medicaid Services (CMS) standards is essential to your success. And just like other areas of the DME industry, there are strict rules that you need to follow. We’re here to provide a brief overview of the DMEPOS supplier standards in an easy-to-read format, so you can continue moving your business forward.  

A Quick History of the DMEPOS Supplier Standards 

In 2003, the Medicare Prescription Drug, Improvement, and Modernization Act included CMS’s DMEPOS Quality Standards. These standards are a comprehensive list of rules you must follow to obtain and retain your DMEPOS billing privileges. 

Along with following the specific standards, you must also become an accredited DMEPOS supplier to receive Medicare billing privileges. Learn how to become a DMEPOS supplier in our previous article. 

What Does CMS Include in Their Supplier Standards? 

The DMEPOS Quality Standards includes two sections and three appendices of information. The two sections focus on the requirements for when a patient orders and receives their equipment. In comparison, the three appendices describe specific equipment and service rules. 

Section 1 Requirements 

You must meet rules regarding the management of your:

  • Finances
  • Office administration
  • Human resources team
  • Product safety
  • Performance management
  • Consumer services
  • Information you provide patients

Section 2 Requirements 

You need to follow product-specific service requirements that involve:

  • Intake and assessment during patient order 
  • Equipment delivery and set-up
  • Instructions with training for patients and caregivers 
  • Patient follow-up

Appendix A

This section includes the rules regarding all respiratory items, supplies, and services.

Appendix B

It provides information on mobility devices from manual and powered wheelchairs and rehabilitative wheelchairs that use assistive technology.

Appendix C

Includes all DMEPOS items that relate to prosthetic devices. In addition, it encompasses all custom-fabricated and fitted options that are part of the patient’s external body.

  • Shoes and inserts 
  • Hands and fingers (somatic body parts)
  • Breasts 
  • Eyes 
  • Ears 
  • Nose 

A Condensed Version of the DMEPOS Supplier Standards

The full version of the DMEPOS supplier standards is a lengthy and complex document. A basic understanding of what it entails before you read the document can make the learning process simpler. We include a brief rundown of the sections and appendices mentioned above to get you started. 

Section 1 

Financial Management 

  • Accurate billing practices 
  • Proper record of revenue and expenses with the prescribed equipment 

Office Administration

  • Someone leading and directing your business activities and operations
  • Display licenses, certificates, and operating permits in a physical location 
  • Only sell patients FDA-regulated medical devices 
  • Implement practices that prevent and eliminate fraud, waste, and abuse

Human Resources Team

  • Hire trained and qualified individuals 
  • Create and update company policies and job descriptions as necessary 

Product Safety

  • Have a plan in place in the event of patient equipment failure 
  • Investigate any potential DMEPOS-related incidents, injuries, or infections
  • Verify patient equipment is in proper working condition before delivery 

Performance Management 

  • Seek referrals and input from employees and patients 
  • Measure responses to several different patient circumstances, including:  
    • Satisfaction and complaints
    • Questions and problems
    • Adverse events due to poor service or malfunctioning equipment and follow-up with patient-practitioner

Consumer Services

  • Provide proper equipment instructions to patients and caregivers 
  • Maintain accurate records of patient’s order history, including:
    • Equipment delivery 
    • Item’s make and model 
    • Rental/purchasing information 
  • Keep proper documentation on customer complaints, investigations, and responses

Information Management 

  • Maintain accurate, accessible, confidential, and secure patient records that meet HIPAA’s standards

Section 2 

Intake and Assessment

  • Keep a copy of the patient’s DMEPOS prescriptions and CMNs in their record
  • Their record should also contain the following:
    • Face-to-face encounter 
    • Physical assessments
    • Practitioner and patient phone logs (if available) 
  • Communicate with the patient’s physician their order and any changes to it 

Equipment Delivery and Set-Up

  • Accurate shipment 
  • On-time delivery 
  • Provide temporary equipment during the repair of their current item 

Patient and Caregiver Instructions 

  • Explain instructions and potential risks with the equipment
  • Document all completed training 
  • Ensure the patient can safely use the equipment

Patient Follow-Up

  • Offer follow-up services, if necessary, with their equipment use or to meet physician’s recommendations

Appendix A – Respiratory Equipment, Supplies, & Services 

  • Provide services 24/7 to meet patient needs
  • Covered supplies include:
    • CPAP devices
    • Home-invasive mechanical ventilators
    • IPPB devices
    • Nebulizers
    • Oxygen devices
    • Respiratory Assist Devices (RADs)
  • Meet all of section two requirements
  • Meet compliance with the American Association for Respiratory Care Clinical Practice guidelines 

Appendix B – Wheelchairs 

  • Includes specific wheelchairs for:
    • Manual options
      • Standard recliners
      • Heavy-duty
      • Standard lightweight
      • Hemi wheelchairs
    • Power Mobility Devices (PMDs) and Power Operated Vehicles (POVs)
    • Group 2 options 
      • Complex rehabilitative power chairs with power options
    • Group 3 options that accommodate rehabilitative accessories and features
  • Meet all of section two requirements
  • Verify and document the chair’s seating, positioning, and specialty assistive technology 
  • Complex rehabilitative wheelchairs with assistive technology must be additional requirements

Appendix C – Prosthetic Devices 

  • You’ll need to complete training on a broad range of prosthetic treatment options
  • If you’re offering custom-fabricated or fitted devices, then you must:
    • Provide follow-up treatment for modification, adjustment, maintenance, and item repair
  • Must have certification, licensing, education, training, and fitting experience in prosthetics 
  • Meet section two’s intake and assessment plus additional requirements 
  • You don’t need to meet section two’s delivery and set-up requirement
  • Meet section two’s training plus other requirements 
  • Meet section two’s follow-up plus other requirements 

Read DMEPOS Quality Standards in Its Entirely 

If you want to read the rules in their entirety, they’re listed in 42 CFR part 424, sec 424.57(c), or read the full version of the standards here. 

Discover How Medbill Can Help You Move Forward 

At Medbill, our vision is to be your DME partner and help providers and suppliers navigate the industry with trustworthy, reliable information. And as a full-service DME billing company, we can provide personalized services and support for your billing department. 

Contact us so we can begin assisting with your billing needs.