What are the qualifications to obtain and retain Medicare DMEPOS billing privileges?
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., those companies should pay you directly. They can then sell to the beneficiary and send claims to Medicare. The bottom line is your customer is the other company or organization. Your customer needs the supplier number as you should not be billing to Medicare.
If you are a retailer, you sell to individuals. The Medicare beneficiary and Medicare pay you. The bottom line is that your customer is the Medicare beneficiary. In order to work with beneficiaries, you must have a supplier number.
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 have billing privileges (which means being in compliance with the supplier standards) if you serve Medicare beneficiaries. One of those standards is that you must be in compliance with all licensure requirements, such as any licenses for your specialty that a retailer must have. You will be asked to provide the appropriate licenses with your application, reactivation or revalidation forms.
Some companies are both wholesalers and retailers. To obtain billing privileges you need all required federal and state licenses.