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.