Becoming a DMEPOS Supplier

Durable Medical Equipment Prosthetics Orthotics Suppliers (DMEPOS) applications for Medicare are handled by the National Supplier Clearinghouse (NSC) of your region.

Claims for DMEPOS are submitted to designated Medicare Administrative Contractors or MACs. These are divided into geographical jurisdictions. Companies bid to be the claims processors for the jurisdictions. Your DMEPOS processor will most likely be different than the Medicare part B processor for your area. Once your application is approved, NSC will communicate this information to you.

These are the MACs for the current jurisdictions:

1. Jurisdiction A
   • National Heritage Insurance Company
2. Jurisdiction B
   • National Government Services
3. Jurisdiction C
   • CIGNA Government Services
4. Jurisdiction D
   • Noridian Administrative Services

Here are the steps necessary for applying to be a DME provider:

1. Obtain an NPI. This can be done online through the CMS Web site: www.cms.hhs.gov , the NPI Web site: https://nppes.cms.hhs.gov/NPPES/welcome.do or by calling:1-800-465-3203. If you are an individual starting a practice, you will need an NPI for the practice and one for each individual in the practice who will be billing for DME.
2. Download an application form from the CMS Web site: www.cms.hhs.gov/CMSforms. This is form 855S. It has detailed instructions for filling it out and providing documentation of your licensure, NPI, facility insurance and your malpractice insurance. The address for the NSC is included in the form.
3. Download Form 588 from the CMS Web site above. This form is required and allows Medicare to pay your claims through electronic funds transfer (EFT). It should be mailed along with form 855S.
4. If all forms are complete and the documentation is accepted, it takes about 60 days to be approved.
5. CMS has recently initiated an online submission process: Medicare’s Provider Enrollment Chain and Ownership System (PECOS). The previous method of applying for a DMEPOS provider number (as described above) required you to complete and submit the CMS-855S Form to your geographic regions National Supplier Clearinghouse (NSC) for the Medicare program. The application can still be submitted by paper, but the long term plan is to convert to electronic only. CMS is still in the process of refining the on-line process. It is recommended that you apply on-line with the PECOS program since all DMEPOS providers will have to register on the PECOS system even if they already have a DMEPOS provider number. One advantage to the internet-based PECOS is the turnover time for review is only 45 days, as compared to a 60 day turnover time for a paper application. One important detail, is that your referral sources must be enrolled in PECOS or you will be denied payment. Providers can enroll online on the CMS website. The ASHT will provide more information on PECOS in the near future.

D. Bash March 2011