Medicare DMEPOS Supplier Participation Agreement - CMS 460

Medicare Participation To sign a participation agreement is to agree to accept assignment for all covered services that you provide to Medicare patients.

A supplier's participation status is referring to whether they wish to accept assignment on claims or not. Although there are some items on which assignment is mandatory regardless of the supplier's participation status. It is not, in any way, referring to whether the supplier wishes to participate in the Medicare program. You may still bill Medicare if you do not choose to sign a participation agreement.

New suppliers, who have not previously submitted a participation agreement, have up to 90 days after the date its number is assigned to choose to participate. If a supplier does nothing, it will be listed as non-participating. If the supplier wishes to become a participating supplier, then it is important to complete the participating agreement form (CMS 460 (PDF, 217 KB)) and send it to the NPE West within the allotted 90 days.

A new supplier who initially submitted an application to become participating cannot change to non-participating within the first 90 days. The supplier has to wait until the end of the year and submit a letter during the open enrollment period. This letter must be received before December 31 in order to become nonparticipating on January 1 of next year.

Note: It is important to note participation status is associated with an entity (tax ID number) and not a location. A business entity with multiple locations under the same tax ID number cannot choose to have different participation statuses for each location. All locations will automatically be assigned the same status (participating or non-participating) depending what the entity has chosen.

Prior to the open enrollment period, which is usually between mid-November and the end of December, the NPE West will send a letter and a participating agreement to each active supplier on file. One letter and agreement will be sent per tax ID number to the mailing address on the supplier file.

Below is additional information about participating and what suppliers need to do if changing their status during open enrollment.

Why Participate
Regardless of the Medicare Part B services for which you are billing, participants have 'one stop' billing for beneficiaries who have non-employment-related Medigap coverage and who assign both their Medicare and Medigap payments to participants. After we have made payment, we automatically send the claim on to the Medigap insurer for payment of all coinsurance and deductible amounts due under the Medigap policy. The Medigap insurer must pay the participant directly.

What to Do
If you choose to be a participant:

• If you are not currently a participating Medicare Durable Medical Equipment, Prosthetics, Orthotics, Supplies (DMEPOS) supplier, complete the blank agreement and mail it with an original signature of an authorized official to the National Provider Enrollment (NPE West). On the form, show the name(s) and identification number(s) under which you bill. This agreement must be submitted only during the open enrollment period. This open enrollment period is between mid-November and the end of December.
• If you wish to change to non-participating, you must submit a letter signed by the authorized official to the NPE West during the open enrollment period. The change will be effective January 1 of the following year.
   

If you decide not to participate:

• Do nothing if you do not have a participating agreement in effect at any location
• If you wish to change to non-participating, you must submit a letter signed by the authorized official to the NPE West during the open enrollment period. The change will be effective January 1 of the following year.

We hope you will decide to be a Medicare participant.

Please call 866-238-9652 if you have any questions or need further information on DMEPOS participation.