Accreditation Update

The Centers for Medicare & Medicaid Services (CMS) is issuing CR6566 to provide further guidance to suppliers of DMEPOS regarding licensing, accreditation, or other mandatory quality requirements that may apply. DMEPOS suppliers should be aware that if they are not identified by the National Supplier Clearing House-Medicare Administrative Contractor (NSC-MAC) as being accredited to supply the specific product/service AND they are not exempt from accreditation, their claims will be automatically denied by Medicare. Edits for the Healthcare Common Procedure Coding System (HCPCS) codes in the product categories designated by MIPPA as requiring accreditation will be in effect for claims with dates of service on or after July 6, 2010.

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What to do now if you are not accredited and "stepped down"

Pharmacies are exempt from DME accreditation requirements until January 2011. After that time, the new health care reform law requires that CMS provide an exemption from accreditation to pharmacies who Medicare DME billings average no greater than 5 percent of total pharmacy sales, have had a Medicare billing number in good standing for the last 5 years and agree to provide certain documentation to prove they meet these criteria. A reading of the law would imply that pharmacies open fewer than 5 years and new pharmacies are not eligible for an exemption. Pharmacies that are currently accredited would not have to get reaccredited if they meet these criteria. We will be working with CMS to make sure that the new law is implemented consistent with Congress's intent. Current law still requires DME suppliers to have a surety bond. Some unaccredited pharmacies may have already stepped down from selling DME. Others may have voluntarily terminated. If you wish to now get back into the program, CMS has provided us with the following instructions:


1. Pharmacies that have "stepped down" MUST immediately amend their National Supplier Clearinghouse (NSC) Medicare Enrolment Application, 855s, and "step up" (select the DMEPOS including diabetes supplies as described in 1C they wish to dispense). It may take up to 90 days for NSC to approve the amendments. Complete Sections 1C, 2 (complete 2A1 and those data elements that are changing), 3, 13, and either 15 (if you are the authorized official) or 16 (if you are the delegated official), and 6 for the signer if that authorized or delegated official has not been established for this DMEPOS supplier.


2. If you have voluntarily terminated, then you must complete all sections of the 855s. To activate once again may take longer than 90 days because the pharmacy must be re-inspected by the NSC to assure that the 25 NSC supplier standards are being met. If you are reactivating your Medicare supplier billing number, complete all sections.


3. Send in your 855s application by registered mail or other tracking carrier to the physical address below.

Overnight Mailing Address National Supplier Clearinghouse Palmetto, GBA* AG-495 2300 Springdale Drive, Bldg. 1 Camden, SC 29020