Novitas Solutions, the National Provider Enrollment (NPE) contractor for the eastern United States recently published an article reminding DMEPOS suppliers to pay attention to the state licensure requirements when submitting an 855-S application or when making updates/changes in PECOS.
The NPE East advised that suppliers do the following when submitting a CMS-855S application to enroll, or update these elements in your enrollment record:
Do not select a State(s)/Territory(ies) or product/service where you are pending licensure because the NPEs are unable to add this information to your enrollment record. They have indicated that they will call for clarification in situations where there are more States/Territories, or products/services reported than typically encountered, however, should extraneous information be provided, your application will be developed.
- Select only the State(s)/Territory(ies) where you are currently licensed to provide items or services to Medicare beneficiaries from the business location provided on the CMS-855S application. For each State/Territory selected, submit all required licenses and/or certifications for the products and services being provided.
- Select only the products and services that you are currently licensed/certified to furnish and submit copies of those licenses and/or certifications. If you fill orders, fabricate, or fit items by contracting with other companies for the purchase of items necessary to fill the order, submit copies of all applicable contracts. Ensure the accreditation information for the selected products/services is included on the application.
It is important to remember that providing excess/unnecessary information complicates the contractors’ verification process and slows processing timelines. Also, failure to attach applicable licensure, certification and/or contracts could result in denial or revocation of your Medicare billing privileges.
Determining which States/Products require licenses
It is recommended that your first step in the research process be reviewing the licensure database. The licensure database was created and is currently maintained by the National Provider Enrollment Contractor West (NPE West), Palmetto GBA, outlining national DME licensure requirements. While national, each state that now resides in the NPEAST DMEPOS, managed by Novitas Solutions, can be located within the database for current requirements. It is important to note that the database should only be used as a guide. The various state boards or regulating agencies have the final determination as to what license is or is not required. It is the supplier’s responsibility to ensure they are in compliance with all state and federal laws and regulations.
After you have checked the licensure database, it is suggested that you follow-up with the state’s licensing board/agency to confirm if a license is required for the state you wish to service patients.
Need some help?
Did you know that the van Halem Group provides enrollment assistance and ongoing enrollment support? Our enrollment expert can assist you with both new and existing applications and can also provide consultation in licensure requirements. Contact us for more information!