Sometimes life isn’t as easy as we hoped it would be. An accident, illness, or injury can happen resulting in the need for extra products and services for our patients to lead their daily lives. For patients requiring these devices, they can rest assured knowing a local community provider is available to help them with their particular needs. In today’s blog, we will discuss why having a DMEPOS compliance program is important, things you can do to get started, examples of other people who thought they didn’t need to have all their DME items in place and the issues they got into and some solutions to help keep your sanity while juggling all the items needed to bill Medicare for DMEPOS items.
Because Medicare is so heavily regulated, it is necessary for providers to have a DMEPOS compliance program in place that matches up with the CMS Supplier Standards. Once you achieve a status that you can bill Medicare, you have to ensure all your support documents are 100% correct; if not, you will lose every audit, every time.
Pharmacies that have been accredited for at least 5 years and are billing 5% or less of total sales of DME items are eligible for a classification known as exemption. While some would think they are exempt from the rules, they are only exempt from the accreditation requirement. So, even if you have achieved exemption status, you still need to have a DME compliance program in place.Do It Yourself (DIY) Compliance
To create your own DMEPOS program, you need to juggle a few items at the same time:
So now that you have about 6 items you are juggling, I’ll assume that you received your Accreditation Certificate, were awarded a PTAN and are ready to start dispensing - Congrats!
Getting Started
Now the tough part starts. If you are a pharmacy, pharmacy language and pharmacy process will not work when dispensing DMEPOS products. This also includes Part B Meds. The staff must understand that the paperwork and the process are different. For example:
The hardest thing with Medicare Part B billing is knowing:
When it comes to Medicare Part B and DMEPOS products, no truer words have ever been spoken than the adage “the Devil is in the Details”. If you’re not sure of your “juggling skills”, but wish to get some help establishing a program or revamping an existing program, the R.J. Hedges & Associates DMEPOS program is designed to fit the needs of any pharmacy or DME facility that is offering DME products. Our program ensures that you have what you need to meet the Medicare requirements and have support documents like streamline Proof of Delivery, DWO's, WOPD, Intake Forms, Assessments, Plan of Care and many more. We will also complete all your Medicare applications and can help with your exemption application.
To test how you are currently doing, feel free to take our DMEPOS Compliance Assessment to see areas you are excelling or areas that may need improvement.
Jenny Schell Sr. Compliance Strategist
If you are dispensing DME products and have a Medicare PTAN you should have some type of program in place. To initially get your PTAN, you have to go through an accreditation, and then every three years go through reaccreditation. There are nine different accreditation companies that you can choose from, and they all have specific items they are looking for which come from the CMS Quality Standards. Just a side note, Medicare has a tendency to change some of these requirements and back date the implementation date. So if you are trying to do this on your own, it’s always a good idea to periodically check dates.
Our DMEPOS program is designed to fit the needs of any pharmacy that is offering DME products. The RJHedges program ensures that you have what you need to meet the Medicare requirements and have support documents like, Receipts of Goods and Services, your Detailed Written Order and Plan of Care. Many people believe if they are under the exemption, the rules don’t apply to them. If you are under the exemption you still must do everything Medicare requires minus the accreditation component. The program is good for people initially seeking accreditation, going through re accreditation, or who have achieved the exemption status.