If you provide DME or DMEPOS items to patients, there are several steps you must complete to submit claims to Medicare for reimbursement. This article will explain the difference between the DME accreditation for Medicare and National Plan & Provider Enumeration System (NPPES) and how each process works.
Before we get started, we want to note that this accreditation process only applies to suppliers who want to submit claims to Medicare. If you only plan to bill private insurance companies, you’ll need to follow their protocols.
Let’s get started.
The Purpose of the DMEPOS and DME Accreditation Process
The accreditation process applies to suppliers who plan to submit their patient’s claims to DME Medicare Administrative Contractors (MAC). And the purpose of the process is to show the Centers for Medicare & Medicaid Services (CMS) that your business meets all their requirements so you can safely sell the items to patients. In addition, it verifies that you meet their Quality Standards and complete your enrollment information. CMS’s goal is to ensure that Medicare patients receive the highest quality care in the safest way.
Why the DME Accreditation is Necessary
CMS sets forth requirements that all DME and DMEPOS suppliers must receive their proper accreditations to submit claims for payment. Once you receive your DME accreditation, you can choose whether or not you want to enroll as a participating provider or a non-participating provider in the Medicare program.
A Simplified Explanation of the DME Medicare Verification Process
Step 1: Obtain an NPI through the National Plan & Provider Enumeration System (NPPES). Make sure to obtain an NPI through the NPPES for each location.
Step 2: Complete the Medicare enrollment application process through PECOS and pay the application fee.*You must obtain accredited status before submitting your application*
Step 3: Work with your assigned MAC representative about any additional requests they need from you.
Step 4: Post a Surety Bond of $50,000 for each of your NPIs to your Enrollment Contractor.
A Simplified Explanation of the 3-Part Accreditation Process
The accreditation processes include many specific steps and details to complete. The purpose of this article is to give you an overview of what you can expect.
Part 1: Pre-Application
- Contact the CMS-approved accreditation organization (AO) for information regarding your organization’s process.
- Apply to the AO of your choice.
- Make the necessary changes to your business to meet its standards.
Part 2: Application Reviewal
- Once you complete all changes mentioned in part one, submit your application with all required documentation.
- The review period is typically 4-6 months from the AO.
Part 3: Unannounced On-Site Survey
- During the review, the AO will conduct an unplanned on-site survey of your business.
- After the visit, the AO reviews your application and on-site survey results.
- They send your application’s approval/denial to the National Supplier Clearinghouse (NSC).
- Accreditation doesn’t follow any events of mergers, acquisitions, or sales. You’ll need to reapply.
- AO performs on-site surveys every three years.
- Learn about the DMEPOS Quality Standards.
- Here’s a list of DMEPOS Accreditation Organizations.
Read more detailed specific information on the DMEPOS accreditation process.
Medbill Can Help Your Business Prosper
We’re a full-service DME billing company that assists DME and DMEPOS suppliers with all their billing needs. After you become a licensed supplier and receive your accreditation, our team is ready to help with your claim’s submission process, AR collections, audit readiness, and more.