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Medicare DME Application Site Visit FAQ's

FAQ's for dental practices enrolling as a Medicare DME supplier for the on-site visit

                                                 FAQ about the site visit

All site visits are unannounced and will be conducted during the hours listed on the application and those hours must match what is posted on the door of the facility

Are suppliers required to have beneficiaries sign a document stating they have received warranty information? Will site inspectors look for this signature?

Answer:
Supplier Standard 6 states, 'The supplier must provide, upon request, documentation that it has provided beneficiaries with information about Medicare covered items covered under warranty, in the form of copies of letters, logs, or signed notices.'
As indicated by the standard, the supplier may choose how to document that warranty information was provided. The NSC site inspector will review the beneficiary file to see if this information was provided.

As a supplier, am I required to document all communications with beneficiaries?

Answer:
Supplier standard 13 requires the supplier 'to answer any questions and respond to complaints a beneficiary has about the Medicare-covered item that was sold or rented. A supplier must refer the beneficiary with Medicare questions to the appropriate carrier. A supplier must maintain documentation of contacts with beneficiaries regarding complaints or questions.'

Therefore, as required by this standard, suppliers should document contacts received from beneficiaries. However, this does not mean suppliers have to document every communication they have with beneficiaries.

For example, if a beneficiary calls to inquire about the hours of operation, the supplier is not required to document this contact. However, if a beneficiary calls with a Medicare-related question, such as a coverage issue or a question about how to operate a certain piece of equipment, the supplier should document these types of contacts in the beneficiary's file. Suppliers may choose how to maintain this documentation.
The intent of this standard is to ensure suppliers are providing a high level of service with regard to the items provided to beneficiaries.

Do I have to submit an authorization agreement for electronic funds transfer (CMS 588) to the NSC?

Answer:
DMEPOS suppliers are required to submit the EFT agreement with the application form when initially enrolling or submitting an application for a new location. Note: For changes to a current EFT agreement, please contact your DME MAC.

When completing the form, suppliers should ensure the form has the original signature of the authorized or delegated official. Further, suppliers must include with each form submitted a voided check, preprinted deposit slip or confirmation of account information on bank letterhead for verification of the account number.

The NSC will then send the agreement to the appropriate DME MAC for processing.

Can I make an appointment for my site visit?

Answer:
Site visits are unannounced and will take place during your posted hours of operation. Supplier Standard 30 requires the location to be in operation for a minimum of 30 hours per week unless exempted by supplier type. If a site inspector visits your location outside of the posted hours of operation, the inspector will attempt a subsequent site visit during the posted hours.

If a site visit is refused or cannot be completed, the supplier is subject to the denial/revocation of Medicare billing privileges.

How many attempts are made to complete a site visit?

Answer:
Generally, two attempts are made to complete a site visit. However, if on the first attempt, the inspector finds the facility is still under construction, finds other obvious indications the facility is not a true operating location, or finds that there is no visible sign or office hours posted, the site inspector will not make a second attempt and the NSC will be notified the site visit could not be completed.

The hours of operation indicate when a supplier is open and available. During these hours, a beneficiary, CMS or its agents should be able to visit the facility. If a supplier goes to lunch from 1 p.m. to 2 p.m., then this needs to be posted along with the hours of operation. If your posted hours state you are open from 9 a.m. to 5 p.m., then the supplier should be available from 9 a.m. to 5 p.m.

Note: Suppliers should not include times of delivery or maintenance to Medicare beneficiaries in their hours of operation.

If a site visit is refused or unable to be conducted, the supplier is subject to the denial/revocation of Medicare billing privileges.

 

How can I be sure the individual present to conduct the site visit is authorized to do so?

Answer:
An authorized site inspector, whether an NSC employee or a contractor, will have a photo identification card and a signed letter on CMS letterhead authorizing the individual to conduct the visit with them. Please note, the inspector will have a camera to take various pictures of the facility, sign, inventory, etc. The inspector will also have a questionnaire to complete based on the supplier standards.
The inspector will ask to review your files to determine if you are in compliance with certain requirements of the supplier standards. However, the site inspector should not take the files, make copies or take pictures of the information contained in the files.
Please notify the NSC immediately if the site inspector requests to take the original or make copies of the beneficiary files, fails to present the photo ID or fails to present the signed authorization letter. You should not give any information to an individual that is not properly credentialed. Please call 866-238-9652 to report any concerns.

What documentation might the site inspector request?

Answer:
The site inspector may ask for copies of any licensure you are required to have in order to operate your business. Copies of your insurance policy, IRS documentation or inventory contracts may also be requested. Depending on the type of supplier being visited, any of the following documents may be requested:

  • Any licensure required to operate the business
  • Insurance policy showing compliance with supplier standard 10
  • An acceptable IRS document
  • Copies of any contracts the supplier may have for inventory, instruction or repair services
  • Complaint log and resolution protocol
  • Rent/Purchase option notification
  • Proof of warranty coverage

What is considered permanent visible signage in regard to Supplier Standard 7?

The supplier should maintain a permanent visible sign(s) in plain view and should post hours of operation. The sign must be visible to the public and posted outside of the facility. If the supplier's place of business is located within a building complex, the sign(s) must be visible at the main entrance and/or lobby area of the building and show the exact location of the supplier within the building. However, the hours can be posted at the entrance of the supplier with a separate sign. Permanent Signage including the hours of operation should not be easily removed or detached by weather or a person who does not have a business need to remove it. Taped paper signs are not acceptable. Beneficiaries should be able to locate the supplier and their hours of operation through the use of these permanent signs without help from the supplier or other parties.