Starting a Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) business requires more than choosing products and preparing to serve Medicare beneficiaries. Suppliers must understand the accreditation and enrollment requirements that apply to their business before they can receive Medicare reimbursement.
One of the most common questions new suppliers ask is: Should you complete DMEPOS accreditation or Medicare enrollment first?
For most DMEPOS suppliers, accreditation comes first. Understanding this sequence can help prevent application delays, reduce compliance problems, and create a smoother path toward Medicare billing privileges.
What Is DMEPOS Accreditation?
DMEPOS accreditation is an evaluation of a supplier’s compliance with applicable Medicare quality standards. A CMS-approved accreditation organization reviews the supplier’s business operations, policies, procedures, and services to determine whether the required standards are met.
The process helps establish that a supplier is prepared to provide equipment and supplies while maintaining appropriate quality and safety practices.
What Does the Accreditation Process Include?
Depending on the supplier’s business and accreditation scope, preparation may involve:
- Developing written policies and operational procedures.
- Establishing appropriate recordkeeping and documentation practices.
- Reviewing staff training and responsibilities.
- Maintaining product safety and customer service procedures.
- Preparing for an accreditation survey or site visit.
Suppliers should confirm that their accreditation covers the specific products and services they intend to provide.
What Is Medicare Enrollment?
Medicare enrollment is the process through which an eligible supplier applies to participate in the Medicare program and obtain billing privileges.
For DMEPOS suppliers, enrollment applications are processed by the National Provider Enrollment (NPE) DMEPOS contractors. Suppliers generally submit their applications through the Provider Enrollment, Chain, and Ownership System (PECOS), although an applicable paper application may also be available.
What Is Required for Medicare Enrollment?
Depending on the supplier’s circumstances, the process may involve:
- Obtaining the appropriate National Provider Identifier (NPI) for each applicable practice location.
- Completing the Medicare enrollment application, CMS-855S.
- Providing accurate ownership, business, and location information.
- Completing the applicable Electronic Funds Transfer authorization requirements.
- Paying the required application fee, when applicable.
- Providing the required surety bond and supporting documentation.
Meeting these requirements does not guarantee approval. The enrollment contractor must review the application and determine whether the supplier satisfies the applicable requirements.
DMEPOS Accreditation vs. Medicare Enrollment: Which Comes First?
For most suppliers, the correct sequence is to obtain required accreditation first and then submit the Medicare enrollment application.
Step 1: Confirm Your Accreditation Requirements
Identify the DMEPOS products and services your business plans to provide. Determine whether your supplier category requires accreditation or qualifies for an exemption.
Step 2: Prepare Your Business for Accreditation
Establish the required policies, records, staff procedures, and operational practices. Select a CMS-approved accreditation organization that covers your intended products and services.
Step 3: Complete the Accreditation Process
Undergo the required evaluation and obtain accreditation before submitting your Medicare enrollment application, unless an applicable exemption or specific rule provides otherwise.
Step 4: Prepare and Submit Your Medicare Application
Obtain the required NPI information, complete CMS-855S through PECOS or the applicable paper process, and provide accurate supporting documents.
Step 5: Complete Remaining Enrollment Requirements
Respond to requests from your enrollment contractor and satisfy applicable requirements, including the surety bond and any required fees.
Do not assume that accreditation alone authorizes Medicare billing. You must also obtain the necessary Medicare enrollment approval and billing privileges.
Common Mistakes That Can Delay the Process
Submitting an Application Before Accreditation
Most DMEPOS suppliers must already be accredited when their enrollment application is submitted. Applying too early can lead to denial or other processing problems.
Choosing the Wrong Accreditation Scope
Accreditation must cover the applicable products and services. A supplier should not assume that accreditation for one product category automatically covers every item it intends to furnish.
Providing Inconsistent Business Information
Differences in business names, ownership details, practice locations, and NPI records can create avoidable questions during enrollment review.
Overlooking Location-Specific Requirements
Each applicable practice location must meet the relevant accreditation and enrollment requirements. Suppliers opening additional locations should coordinate with their accreditation organization and enrollment contractor before proceeding.
How Can DMEPOS Suppliers Prepare More Efficiently?
A clear preparation plan can help suppliers manage the process with fewer avoidable setbacks.
- Confirm the applicable accreditation and exemption requirements.
- Verify state licensing requirements for the products and locations involved.
- Organize business ownership and location documentation.
- Prepare operational policies before the accreditation survey.
- Verify NPI and enrollment information for each applicable location.
- Track application submissions and requests for additional information.
Working with an experienced DMEPOS accreditation or enrollment consultant may help organize the process. However, suppliers should verify the consultant’s experience and understand that no consultant can guarantee approval.
Frequently Asked Questions
Can I apply for Medicare before obtaining DMEPOS accreditation?
Most suppliers subject to the accreditation requirement must obtain accreditation before submitting their Medicare enrollment application. Certain categories are exempt, so confirm your eligibility before applying.
Does DMEPOS accreditation guarantee Medicare approval?
No. Accreditation addresses applicable quality standards, while Medicare enrollment involves additional eligibility, documentation, licensing, and supplier requirements.
What is CMS-855S?
CMS-855S is the Medicare enrollment application used by DMEPOS suppliers. It collects information about the supplier’s business, ownership, locations, and other relevant details.
Do all DMEPOS suppliers need a surety bond?
Most covered DMEPOS suppliers must meet the applicable surety bond requirements. Certain exemptions and exceptions may apply, so suppliers should verify the rules for their circumstances.
Can a supplier open another location after accreditation?
Additional locations require careful review of accreditation and enrollment requirements. Suppliers should notify their accreditation organization and ensure the new location meets applicable standards before proceeding.
Final Thoughts
DMEPOS accreditation and Medicare enrollment serve different purposes, but both are important for suppliers seeking Medicare billing privileges.
For most suppliers, accreditation comes first, followed by the Medicare enrollment application and completion of the remaining requirements. Preparing documentation, confirming product coverage, and understanding location-specific obligations can help reduce avoidable delays.
All State can help DMEPOS suppliers understand accreditation preparation and Medicare enrollment requirements, allowing business owners to approach the process with a clearer plan.
Disclaimer: This article is for general educational purposes and is not legal or regulatory advice. Requirements may vary by supplier category, location, and applicable CMS rules. Verify current requirements with CMS, your accreditation organization, and the relevant enrollment contractor.
