What are the qualifications to obtain and retain Medicare DMEPOS billing privileges?

Answer:
In order to obtain and retain Medicare DMEPOS billing privileges, suppliers must:

• Be in compliance with the current version of the supplier standards
• Be selling retail directly to a beneficiary, not solely to another company or organization (such as a nursing home or hospital)
• Not be on an exclusions database

The Distinction Between a Wholesaler and a Retailer
If you are a wholesaler, you sell to other companies such as hospitals, nursing homes, etc. and those companies should pay you directly. Those companies can then sell to the beneficiary and submit claims to Medicare. The bottom line is your customer is the other company or organization and not the Medicare beneficiary. 

If you are a retailer, you sell directly to individuals, including Medicare beneficiaries. The bottom line is your customer is the Medicare beneficiary. In order to receive payment or service Medicare beneficiaries, you must have billing privileges.

As a wholesaler, you cannot obtain billing privileges. You should be collecting money directly from the companies to which you sell your product. You will not obtain billing privileges because your customer is not the Medicare beneficiary.

As a retailer, you must be enrolled as a Medicare supplier and have billing privileges (which means being in compliance with the supplier standards) if you serve Medicare beneficiaries. One of those standards is being in compliance with all licensure requirements. You will be asked to provide the appropriate licenses with your application, change of information, reactivation or revalidation.

Some companies are both wholesalers and retailers. To obtain billing privileges you need all required federal and state licenses.