Health Care Reform Impacts DME Accreditation
posted: 03/31/2010

Last week, President Barack Obama signed a health care reform bill that impacts durable medical equipment (DME) accreditation requirements for pharmacies. Pharmacies are now exempt from DME accreditation requirements until January 2011. After that time, the new health care reform law requires that the Centers for Medicare & Medicaid Services (CMS) provide an exemption from accreditation to pharmacies with Medicare DME billings that are no greater than 5 percent of their total pharmacy sales; have had a Medicare billing number in good standing for the last five years; and agree to provide certain documentation to prove they meet this criteria. The law states that pharmacies open for fewer than five years and new pharmacies will not be eligible for this exemption. Pharmacies that are currently accredited would not have to get reaccredited if they meet these criteria.

Current laws still require DME suppliers to obtain a surety bond and send a copy of it to the National Supplier Clearinghouse (NSC). Providers needing to obtain a surety bond for their pharmacy can contact PSI Insurance Agency at (800) 678-2774, ext. 237 or 250. Or, for additional information on surety bond requirements, visit the CMS Web site.

Some unaccredited pharmacies may have already stepped down from selling DME, and others may have voluntarily terminated their application. If you wish to get back into the program, CMS has provided the following instructions:

  1. Pharmacies that have stepped down must immediately amend their NSC Medicare Enrollment Application, 855S and select the durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) including diabetes supplies described in section 1C if they wish to dispense. It may take up to 90 days for the 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 your supplier status, you must complete all sections of the 855S. Reactivating your supplier status may take longer than 90 days because the pharmacy must be reinspected by the NSC to assure that the 25 NSC supplier standards are met. If you are reactivating your Medicare supplier billing number, complete all sections.

  3. Send in your 855S applications by mail or other tracking carrier to the address below:
    National Supplier Clearinghouse
    Palmetto, GBA* AG-495
    2300 Springdale Drive, Bldg. 1
    Camden, SC 29020

  4. If you haven’t already, obtain a surety bond and send a copy of it to NSC.


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