Orthotics & Prosthetics Suppliers
All suppliers are required to be in compliance with the Medicare DMEPOS supplier standards. As a supplier of Orthotics and/or Prosthetics (O&P), keep the following in mind as you operate your business.
Supplier Standard # 1 states a supplier 'operates its business and furnishes Medicare-covered items in compliance with all applicable Federal and State licensure and regulatory requirements.' If your state requires an O&P license or certification for these types of specialties and products/services, then a copy of this license must be included with the CMS 855S application form.
Supplier Standard # 4 states a supplier 'fills orders, fabricates, or fits items from its own inventory, or by contracting with other companies for the purchase of items necessary to fill the order. If it does, it must provide, upon request, copies of contracts or other documentation showing compliance with this standard.' The Centers for Medicare and Medicaid Services (CMS) interprets 1834 (j) (1) of the Social Security Act to mean the supplier must be the one furnishing the services/items, and must be the one billing for the services/items. Specifically, a supplier may not contract with other companies for services.
Supplier Standard # 12 states a supplier 'is responsible for delivery and must instruct beneficiaries on use of Medicare covered items and maintain proof of delivery.'
Pursuant to Title 42 of the Code of Federal Regulations, Secs. 405.874 and 424.57, your CMS 855S application form will be denied if you are not in compliance with these standards as a supplier of O&P. These denials have the concurrence of CMS.
If you have any questions, you may call the NSC toll free at 866-238-9652.