Many of our clients have recently received notifications about upcoming Medicare inspections at their optical locations. While these notices are helpful and the visits have typically been brief—mainly ensuring the optical location is operational, hours are posted, and service handouts are available for patients—there is still the possibility of a more thorough audit. As credentialed Durable Medical Equipment, Prosthetics, and Orthotics Suppliers (DMEPOS), Medicare suppliers must meet specific Supplier Standards.¹ The CMS has published an MLN Educational Tool to assist in understanding these standards. In this article, we’ll review the key requirements² that some optical locations may have overlooked, helping you ensure full compliance.

• A supplier must fill orders from its own inventory, or contract with other companies for the purchase of items necessary to fill orders. A supplier may not contract with any entity that is currently excluded from the Medicare program, any State health care programs, or any other Federal procurement or non-procurement programs.
  
  o Just as a medical practice, a business that accepts Federal reimbursement must confirm that no one with an interest in the optical appears on a Federal exclusion list.³ Implement a practice for exclusion checking upon hire and quarterly.

• A supplier must notify beneficiaries of warranty coverage and honor all warranties under applicable State law, and repair or replace free of charge Medicare-covered items that are under warranty.
  
  o Ensure your optical has a written warranty to provide to patients and review with them. 

• A supplier must disclose these standards to each beneficiary it supplies a Medicare-covered item.
  
  o Per Medicare’s Supplier Standard, this paragraph is an acceptable notice for the patient: The products and/or services provided to you by (supplier legal business name or DBA) are subject to the supplier standards contained in the Federal regulations shown at 42 Code of Federal Regulations Section 424.57(c). These standards concern business professional and operational matters (ie, honoring warranties and hours of operation). The full text of these standards can be obtained at http://www.ecfr.gov. Upon request, we will furnish you a written copy of the standards.

• A supplier must disclose any person having ownership, financial, or control interest in the supplier.
  
  o Create a posting of ownership for each optical location where patients can easily access it.

The following 3 requirements overlap and can be addressed as a group:

• A supplier must answer questions and respond to complaints of beneficiaries, and maintain documentation of such contacts.
• A supplier must have a complaint resolution protocol established to address beneficiary complaints that relate to these standards. A record of these complaints must be maintained at the physical facility.
• Complaint records must include: the name, address, telephone number and health insurance claim number of the beneficiary, a summary of the complaint, and any actions taken to resolve it.
  
  o Create a complaint standard operating procedure that supports prompt complaint resolution and documentation. Train all optical staff on the protocol.

Conclusion

By proactively addressing these Medicare Supplier Standards, optical locations can ensure compliance and minimize the risk of audit findings. Implementing clear policies, maintaining accurate documentation, and training staff on regulatory requirements will support a smooth inspection process. OP

REFERENCES:

1. Palmetto GBA. Abbreviated Standards for Reasonable and Necessary Criteria. Published February 8, 2016. https://www.palmettogba.com/Palmetto/Providers.Nsf/files/abbreviatedstandards020816.pdf/$File/abbreviatedstandards020816.pdf

2. Centers for Medicare and Medicaid Services (CMS). Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Quality Standards. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/DMEPOSQuality/DMEPOSQualBooklet-905709.html

3. Office of Inspector General (OIG). Exclusions Database. https://exclusions.oig.hhs.gov/?AspxAutoDetectCookieSupport=1 

Laurie Brown, MBA, COMT, COE, CPC, CPMA, LSSYB, is a senior consultant with VMG Health (formerly BSM Consulting) in Tucson, Arizona. She has experience in the ophthalmic industry holding managerial, clinical, and surgical roles for more than 35 years.