Q: After 25+ years as a DME provider, my recent DMEPOS revalidation was rejected because of a lack of a contract to provide shoes. I don’t make much money on DME ($8K per year) but don’t want to lose this ability. Do I have any recourse?
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I have received calls like this all year. Typically, the provider tells me his biller submitted the DME application and they have done this repeatedly once every few years. Does this make someone an expert? If you had to have surgery and the surgeon told you they only perform this procedure once every three to five years, what would you do?
A recent conversation with a new client demonstrated that despite them telling me they did not do much DME, morphed into a $24,000 income from DME over three years. That’s $8,000 per year. If the enrollment specialist charged you $1,000 that’s equivalent to $333 a year. Would you invest $1,000 to secure a $24,000 income $1 a day to guarantee an $8K annual income?
Another issue is that you will now need to be admit to being disenrolled from a Federal Contractor when answering certain Medicare Part C, your local Medicare contractor, Medicaid and third party payers. This will require an essay to explain why you were disenrolled. Not something I would particularly like to explain.
The best answer is not to allow this to happen to you. Hire an expert to complete your DMEPOS application as soon as you receive a revalidation notice. The application continues to morph becoming a more complicated instrument not to be entrusted to someone who is unfamiliar with their complexity.
As for an answer to this situation. You have a small window of time to submit a Corrective Action Plan (CAP). That CAP should contain the required information. For every category of DMEPOS you provide, you should have at least one contracted vendor you do business with. Those contracts should be submitted to the NPI for your region.
Contracts should list a credit limit, when their payments are due and how payment is to be made. The vendor’s list of services and products they provide should also be clearly outlined in this contract. Other information your vendor should provide include turnaround time for orders, their address, customer service number and where product warranty information may be found.