CMS Says Occupational Therapists Exempt from DMEPOS Accreditation Requirements
The Centers for Medicare & Medicaid Services (CMS) held a Special Open Door Forum (ODF) on September 3 to inform physicians and certain licensed health care professionals who supply durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) that they no longer need to become accredited prior to obtaining a supplier number from the National Supplier Clearinghouse (NSC). Exempt professions include the following (among others):
- Occupational therapists
- Physical therapists
- Speech language pathologists
- Physician assistants
- Nurse practitioners
- Clinical nurse specialists
The purpose of this Special Open Door Forum was to provide guidance to DMEPOS providers on the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). MIPPA section 154(b) added a new subparagraph (F). This subparagraph states that eligible professionals and other persons are exempt from meeting the September 30, 2009 accreditation deadline unless CMS determines that the quality standards are specifically designed to apply to such professionals and other persons. According to CMS, Acting Secretary Kerry Weems used his discretion to exempt certain eligible professionals and other persons from accreditation requirements based on the language and intent of MIPPA.
How the Announcement Affects Occupational Therapists
The Medicare Accreditation rule was originally released in the Federal Register on August 2, 2006. It required that occupational therapists, physicians, physical therapists, and others who supply DMEPOS as part of ongoing patient care would have to be accredited by a CMS-approved accreditation organization in order to bill Medicare Part B for DMEPOS. This meant that in order to bill either custom-fabricated or pre-fabricated orthotics (using the Level II HCPCS codes or “L” codes) to a DME Medicare Administrative Contractor (MAC) using an NSC number, occupational therapists would be required to have a separate accreditation as a “supplier.” Occupational therapists working in SNFs, CORFs and other Medicare certified facilities do not need a NSC supplier number and they don't need to be accredited. In these settings the facility bills CPT and HCPCS codes to a fiscal intermediary (FI) or MAC (Medicare Administrative Contractor).
As a result of this announcement, occupational therapists in private practice (OTPP) are no longer required to go through the accreditation process; thus, the September 30, 2009 deadline for accreditation no longer applies to OTPPs. This is a positive outcome for occupational therapists who bill for orthotics or other DMEPOS because it means that they will no longer be subject to the financial burden of accreditation, which can range from $2,000-$5,000 over a 3-year period. At this time, CMS stated that they are not planning to design specific accreditation standards for occupational therapists, although they have the regulatory authority to do so at any point in time.
This decision represents a significant victory for AOTA. AOTA and a coalition of other health care organizations met with CMS officials on Wednesday, August 27, to discuss accreditation requirements for health care professionals. AOTA sought full exemption from accreditation requirements for occupational therapists. CMS officials were receptive to AOTA’s concerns and stated that they would announce a decision during the September 3 Special Open Door Forum.
If you are an occupational therapist who has been denied an NSC supplier number due to a failure to meet the DMEPOS accreditation requirements, CMS advised that you should resubmit your application to NSC. NSC has been advised that certain DMEPOS suppliers are exempt and CMS expects NSC to be properly processing supplier applications by September 8, 2008.
Other DMEPOS suppliers who were not specifically exempted by CMS will still need to comply with the September deadline. Note that accreditation is different from the DMEPOS competitive bidding program under Medicare. Due to AOTA advocacy two years ago, occupational therapists in private practice who bill Medicare for items of DMEPOS have already been exempt from bidding for those items under the competitive bidding program.
CMS issued a DMEPOS Accreditation MIPPA Fact Sheet to provide guidance to patients and providers. Further information is available on the CMS Web site.