Resources on DMEPOS

Final Rule on DMEPOS Surety Bond

CMS FAQ on DMEPOS Surety Bond Exemption for Ophthalmologists

DMEPOS Accreditation & Surety Bond Exemption Chart

MedLearn Matters Article on DMEPOS Surety Bond

List of Authorized Surety Bond Agents

ASCRS/ASOA is working with the Centers for Medicare and Medicaid Services (CMS) and the NSC to resolve member concerns related to recent Notice of Revocation letters that were sent by the NSC to several ophthalmic practices. According to the NSC, on August 21, 2009, thousands of letters were mailed to suppliers, including ophthalmologists, whose NSC file indicated a surety bond or accreditation were required. For the vast majority of ASCRS/ASOA members, the letters were sent because their NSC file did not reflect Ophthalmologist, Physician, or Optometrist - specialties qualifying for the surety bond exemption - but rather listed Optician as the supplier type. For those that did not contact the NSC customer service center to make a correction to their supplier type on form CMS 855S, a Notice of Revocation letter was sent.  

According to the NSC, if a supplier has received a Notice of Revocation, they must follow the instructions on the letter by submitting either a Corrective Action Plan (CAP) within 30 days of the postmark of the letter or a Reconsideration within 60 days of the postmark of the letter to avoid revocation and a one year ban from participation in the Medicare program.  The CAP must specifically state the supplier is submitting a CAP or Reconsideration. The appropriate sections of the CMS 855S form that practices should update in order to change their Primary Specialty are: section 1A, 1B, 1C, 2A1, 2B (Type of Supplier), 3 and Section 15.

If you have a specific question or concern related to a letter you received from the NSC, please call the ASCRS/ASOA Government Relations Department at 703-591-2220.

From the Washington Watch Weekly

Centers for Medicare and Medicaid Services (CMS) Address Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Surety Bond Exemption for Ophthalmologists (September 11, 2009)

This week, CMS addressed ASCRS' questions regarding the surety bond exemption for ophthalmologists who dispense post-cataract eye wear. CMS has long said that the surety bond exemption for physicians only applied if the physician was dispensing DMEPOS to his/her own patients; however, it has been unclear what a "physicians own patients" actually meant. As a result of our communications with the agency, CMS has issued the following FAQ to clarify how the exemption applies to members that dispense post-cataract eye wear. Review the FAQ online at the National Supplier Clearinghouse web site.

Q:  How does an optometrist or ophthalmologist who dispenses eyeglasses qualify for the physician exemption?

A:  An optometrist or ophthalmologist who dispenses eyeglasses can qualify for the physician exemption if the glasses are furnished only to his/her own patients as part of his/her own service.   For purposes of this exemption, a “patient” is someone who, for instance, receives an eye exam or other diagnostic test from the physician prior to receiving the glasses.  The term “patient” does not include, however, a person who walks into the physician’s office with a prescription for glasses that was issued by another physician and simply receives the glasses without any sort of examination or test being furnished. 

The same general principle applies to an enrolled optical center owned by an optometrist or ophthalmologist.  The center can only qualify for the physician exemption only if: (1) the shop and the physician’s practice are under/within the same TIN and business structure (e.g., part of the same corporation), and (2) the glasses are furnished only to the optometrist/ophthalmologist’s own patients as part of his/her own service.  The term “patient,” again, would not include a person who enters the optical center with a prescription for glasses that was issued by another physician and simply receives the glasses without any sort of examination or test being performed by the optical center. 

Additional Resources

CMS Web page on DMEPOS Surety Bond

CMS Web page on DMEPOS Accreditation