For an unannounced Durable Medical Equipment (DME) site visit, you'll need to have readily available documentation demonstrating compliance with DMEPOS supplier standards, including licensure, insurance, inventory, complaint resolution protocols, and instructions for beneficiary use. The inspector will verify this information and may also take photographs of the facility. This should not be a surprise. When you applied for your DME ID number, you filled out the Medicare enrollment application, form CMS-855S, and when you signed the application, you agreed to follow the rules. Here are the rules for what needs to be present when an unannounced DME on site visit occurs.
Name, Address and Telephone number of the place of service: The name of the physician or organization that obtained the DME number must be on the entry door of the building/office. The hours that the practice is open must be on the entry door, as well and must be the same as the hours that were listed on form CMS-855S. The telephone number that was provided to the DME Regional Contractor must be the same as the telephone number in the office. If the inspector comes into the office, pulls out his cell phone and dials the telephone number that was listed on form CMS-855S, the telephone in the office had better ring.
Licensure: Ensure all required licenses are current and readily accessible.
Insurance: Have a Certificate of General Liability Insurance showing compliance with supplier standards. This is the insurance that you have for the premises. THE DME Regional Contractor must be listed as an additional insured. This needs to be available upon request.
Inventory: Keep records of inventory, including invoices for covered items.
Complaint Resolution: Maintain a complaint resolution protocol and log. This would be an accurate, up to date list of returns, exchanges and items that are being repaired.
Warranty Coverage: Have documentation for warranty coverage of equipment. This would be necessary for all items that have warranty coverage.
Instructions: Provide documentation for written instructions and information on the beneficiary's use and maintenance of supplies.
Accreditation: Have proof of accreditation by a CMS-approved accrediting organization.
Surrey Bond Agreement: Have a surety bond agreement.
Ownership/Management: Have a listing of all owners/management.
During the Visit:
-The inspector will likely request to review these documents.
-The inspector will also be documenting observations about the facility.
-Refusal to permit the visit could lead to denial or revocation of Medicare billing privileges.
Inspector Credentials:
-The inspector will possess a photo identification and a CMS-issued authorization letter.
-You may request to review these documents but cannot copy or retain them.
This is my opinion.
Michael G. Warshaw, DPM, CPC
Terrific NEWS!!!
THE 2025 PODIATRY CODING MANUAL IS NOW AVAILABLE in either Book or Flash-drive formats. It has been completely updated for the calendar year 2025 including the NEW policy for the application of skin substitutes that goes into effect February 12, 2025. Many offices across the country consider this to be their “Bible” when it comes to coding, billing, and documentation. The price is still only $125 including shipping! To purchase, access the website drmikethecoder.com.
No credit card? No problem! Just send a check for $125 to the following address:
Dr. Michael G. Warshaw
2027 Bayside Avenue
Mount Dora, Florida 32757
Read Comments