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Changes To Provider Enrollment

Tuesday, May 9th, 2023

Hi, my name’s Denise Leard. I’m a healthcare regulatory attorney with the law firm of Brown & Fortunato. We’re based in Amarillo, Texas, but I have a large national practice where I work with providers and suppliers all over the United States, helping them with various issues.

Today I want to talk to you about some recent changes to provider enrollment for my durable medical equipment suppliers. So if you’re a DME supplier, one of the most important things you can do is obtain and maintain your Medicare enrollment privileges. And it’s important because even if you’re not going to provide services to Medicare beneficiaries, you’re still going to need that enrollment a lot of times if you’re going to work with Medicaid providers, managed care organizations, and other third party contractors. So key to your business is going to be staying in compliance with those regulations.

Well, things have been great, but Medicare has recently made some changes to it. So back in 1993, the National Supplier Clearing House was given the contract to control and work the enrollment for DME providers throughout the country. On November of this last year, November 6th, that changed. The contract has now been split into two providers. The National Supplier Clearinghouse, Palmetto GBA was awarded the Western contract for the Western United States. So everything west of the Mississippi is going to work with Palmetto. If you happen to be on the east part of the US, you’re going to be working with a new entity, Novitas. Now, Novitas has been involved with provider enrollment for a very long time, however, they’re new to working with our DME/DMEPOS enrollment.

So what’s going to be changing? You’re going to have two contractors depending on what part of the country you’re located in you may work with both of them. And one of the key things that you need to pay attention to is changing your certificate of insurance certificate holder. So currently for most suppliers, that’s going to be the National Supplier Clearinghouse. But if you are going to be governed by the national provider enrollment, east contractor, Novitas, you need to go and update that.

What’s not going to be changing? Well, certain things aren’t going to change. The contractors are still going to be responsible for enrollment of providers. They’re still going to be responsible for re-validation. They’re going to be responsible for ensuring compliance with the Medicare supplier standards.

And that’s what I want to spend just a little bit of time talking to you about right now, dealing with and working with Medicare DME suppliers on a regular basis, I see a few of the supplier standards, there’s 30 supplier standards, that kind of come up over and over when I see revocations or other issues and I want to briefly discuss those. So the first one is compliance with federal, state, and local licensure. That’s supplier standard number one. And in particular, I see providers get in trouble if they’re in multiple states. So if you’re providing services in multiple states, you need to make sure you’re in compliance with all the licensure requirements in those states.

The other one is updating your applications. You have 30 days to update your enrollment provider of any change in information that you previously reported. I encourage you all to go online through PECOS, take a look at what’s on there, and see if you need to make any updates to that.

The other issue that I see is related to the insurance, and you have to have a minimum of $300,000 in comprehensive liability insurance, must cover all of the business and all of the customers and employees who come into the location.

The other issue that I see is related to supplier standard number 22, which is working with an approved, accredited organization. There are very few exceptions., happy to talk about those exceptions with you if you need some help with that. But as a general rule, you have to be accredited and you have to be accredited by an approved accrediting organization. People get into trouble, suppliers get into trouble when they add a new product and they haven’t had their accrediting organization add that to their profile. So very important to communicate with your accrediting organization and make sure that is always up-to-date.

The other thing that you need to always make sure that you do is update if you’re going to provide new products because if you haven’t listed that you’re providing a certain product, the NSC could come and revoke your number for that. So again, I think it’s always a good time, at least on an annual basis, even if a re-validation isn’t required, to go and check and make sure that information is there.

Another area that is important is your surety bond requirements. You have to have a minimum surety bond of $50,000. Some suppliers, depending on their history of adverse actions, may be required to have a larger bond in place, but that bond has to be in place. If for some reason you switch bonds, you need to update that. If the bond company goes out of business and is no longer valid, you’ll need to update that. If you have a gap where you don’t have a surety bond in place, that will be a revocation and it’s not something we can work around to have the number reinstated.

And the final area where I see a lot of issues is related to the hours of operation. A supplier must be open 30 hours a week, and if you’re not open when the NSC comes to do a site visit, then you can have your number revoked for being non-operational. Because you get to choose your hours, this should be an easy one, but you would be surprised at how many times I work with suppliers who weren’t there when they should have been.

I’m going to encourage everybody to pull a copy of the supplier standards. Go through those, take a look at them, make sure you’re in compliance. The other thing I’m going to encourage you is to put together a notebook and have that notebook have everything you need to show compliance with your supplier standards. That way if you have a site visit that takes place and your manager doesn’t happen to be there, even the front receptionist could handle that for you.
If you have any questions, please feel free to give us a call at Brown & Fortunato.