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Additional CMS Requirements for Optical Shops

CMS has issued a Final Rule creating an additional, more rigorous, screening process for suppliers of DMEPOS, which includes Medicare-covered post-cataract eyeglasses.

You already know that Medicare now requires all DMEPOS suppliers to revalidate your supplier information every 3 years. Beginning March 25, 2011, there is a $500 fee for processing that enrollment revalidation (adjusted annually based on consumer price index).

CMS has also determined that, although physicians are usually subject to the lowest level risk category, DMEPOS suppliers are subject to moderate-level risk category requirements. This means that enrolling or revalidating physicians are subject to the following requirements:

  • Verification of provider/supplier specific requirements established by Medicare
  • License verifications
  • Database checks to verify:
  • o Social Security number
  • o NPI checks
  • o National practitioner databank information
  • o OIG exclusion
  • o Taxpayer ID checks
  • o Other information such as recent deaths and other practice changes

DMEPOS suppliers are subject to the above plus:

  • Unscheduled and unannounced site visits
  • $500 enrollment and revalidation fee

All new DMEPOS supplier applications are also subject to high-risk provisions, including fingerprint-based criminal-history record checks.

Many physician practices who currently provide post-cataract eyeglasses to their patients will find that the new $500 fee and other requirements do not meet a positive cost/benefit analysis and will elect to dis-enroll from the ranks of Medicare’s DMEPOS suppliers. If you decide to do this or just want more information, please contact us at (800) 399-6565 or scorcoran@corcoranccg.com.

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