how to become a medicare supplier

1. What is the NABP DMEPOS Accreditation Program? How long is DMEPOS accreditation valid?

It is an accreditation program offered by the NABP for licensed pharmacies that distribute certain DMEPOS products and services and bill Medicare Part B for these products and services. The NABP DMEPOS accreditation program is approved by the US Department of Health and Human Services Centers for Medicare and Medicaid Services (CMS). DMEPOS accreditation is valid for three years. DMEPOS-accredited pharmacies undergo an annual participation compliance review.

2. Who is eligible to apply for NABP DMEPOS accreditation?

The NABP DMEPOS accreditation program can only service suppliers who:

  • possess a current valid state pharmacy license, and
  • distribute only DMEPOS products and services that fall within NABP’s scope.

3. What are the steps required for a pharmacy to become DMEPOS accredited? What is the time frame for the accreditation process?

  • Suppliers submit application materials and all required documentation to NABP. Additional information about application materials is available under Application Instructions .
  • NABP assesses application materials to ensure that CMS quality standards are met.
  • Unannounced survey of pharmacy is performed to compare the pharmacy’s written policies and procedures to its actual practices.
  • When capacity permits, the NABP goal is to complete the DMEPOS accreditation process within six to nine months from verified submission of all required documentation.

4. Is DMEPOS accreditation mandatory?

DMEPOS accreditation is required for suppliers who wish to obtain or maintain Medicare Part B billing privileges for products and services that are subject to CMS’s quality standards.

In addition, please note:

  • Pharmacies that already have a Medicare Billing number, also known as the National Supplier Clearinghouse (NSC) number, will need to be accredited on or before January 1, 2011. If not accredited by that date, the supplier's NSC DMEPOS billing privileges may be revoked.
  • Suppliers with lapsed NSC numbers must be accredited before the NSC number can be reactivated.
  • New DMEPOS suppliers must be accredited before an NSC number can be obtained.

5. I only dispense Medicare Part B drugs, no DMEPOS products or services. Do I need to be accredited to keep my provider number?

Drugs used with DME (eg, inhalation drugs, drugs infused with a DME pump) are not subject to CMS quality standards or accreditation. Likewise, other Part B drugs identified in section 1861(s) of the Act (eg, immunosuppressive drugs, oral anti-emetic drugs) are not subject to the quality standards or accreditation, either. Thus, pharmacies that dispense only Part B drugs and do not furnish any DMEPOS subject to the CMS quality standards do not need to be accredited.

More information on the items subject to CMS quality standards, including drugs and pharmaceuticals, is accessible here .

Although accreditation is not required to dispense products not subject to the quality standards, suppliers are required by the NSC to obtain/maintain a Medicare Billing number by submitting or updating a Medicare Enrollment Application (also known as the CMS-855S). Please contact the NSC for more information about the CMS-855S form. The toll-free phone number: 1-866/238-9652 from 9 a.m. until 5 p.m. EST to reach a customer service representative. The automated response

system is available 24 hours a day.

6. What is the cost for DMEPOS accreditation through NABP?

The cost of accreditation for a single pharmacy is shown below.

Application Fee: $1,250

NABP Survey Fee: $1,500

NABP Survey Travel Fee: $500

Participation Fee (Year 1): $125

Year 1 Subtotal: $3,375

Annual Participation Fee (Year 2): $125

Annual Participation Fee (Year 3): $125

Estimated total for three-year accreditation*: $3,625

*Accreditation fees are subject to change.

Credit card payment is required for Year 1 when the application is submitted. If a pharmacy is not successful at survey, an additional survey and fees will be required to continue in the accreditation process.

A separate fee structure applies to suppliers with more than one facility. For information on fees for two or more facilities that have common ownership and follow the same policies and procedures, please contact DMEPOS staff at dmepos@nabp.net.

Once awarded, DMEPOS accreditation is issued for a three-year term. NABP requires an annual compliance review and program participation fees in Years 2 and 3. Reaccreditation prior to the expiration date of the current accreditation is necessary to maintain continuous accreditation.

7. How do I apply for NABP DMEPOS accreditation?

The application for DMEPOS accreditation for a single pharmacy is only available online. There are different application instructions for suppliers with more than one facility; please e-mail your information to NABP at custserv@nabp.net .

8. What products has CMS approved for NABP accreditation? What are my options if my pharmacy carries products or provides services in addition to those NABP is approved to accredit?

NABP is authorized by CMS to accredit only non-custom, off-the-shelf DMEPOS products and services. More information on NABP’s scope of products is available here. If you have more products or services than those CMS has approved NABP to accredit, another accrediting organization might be better equipped to serve your needs.

9. What is a Surety Bond? Is it a requirement for DMEPOS accreditation?

While the surety bond is not required for accreditation, it is required to retain your Medicare billing number.

A DMEPOS surety bond is a bond issued by an entity (the surety) guaranteeing that a DMEPOS supplier will fulfill an obligation or series of obligations to a third party (the Medicare program). If the obligation is not met, the third party will recover its losses via the bond. DMEPOS suppliers enrolled in Medicare are required to obtain and submit a $50,000 bond for each National Provider Identifier (NPI) to the NSC. See the NSC's Surety Bond FAQ for more information or visit the US Department of Treasury Web site for a list of certified surety bond companies.

10. Do I need to prepare a manual in order to become accredited by NABP?

A manual, per se, is not required. However, all supporting documentation requested with the application must be submitted to NABP for review. For a list of the required supporting documentation, please review the application instructions ; guidance information for preparing supporting documentation is provided in the online application. In addition, a Survey Preparation Guide will be provided to applicants prior to survey.

11. How often will surveys be performed?

Source: www.nabp.net

Category: Insurance

Similar articles: