03/05/2016    George Jacobson, DPM

DMEPOS Billing Privileges Can be Lost Through Inactivity

I would like to warn everyone of a nuance that
will cost you the ability to bill Medicare for
your DME. It was a painstaking process to obtain
this privilege, and although I stopped providing
diabetic footwear, we did not want to lose this
privilege. Had I known the following information,
I would have continued providing shoes for a
selected number of patients.

We received a letter from Palmetto GBA stating
that they have received information from the
National Supplier Clearinghouse (NSC) indicating
that we have not billed the Durable Medical
Equipment Medicare Administrative Contractor (DME
MAC) within the last four consecutive quarters.

As per 42 CFR 4214.540 (a)(1), the NSC is de-
acvtivating your Medicare billing privileges. To
re-activate your DMEPOS billing privileges, you
will be required to submit the most current
version of the CMS 855S form... Essentially re-
apply.

Don't let this happen to you if you want to
continue to have this privilege without having to
go through the process again. I don't like to give
up any privileges that I have worked for, but for
now, good riddance. If the day comes that we are
trusted be the attesting doctor (not in my
lifetime), then I'll painstakingly re-apply.

I still maintain that they have all the ICD-10
data, lab data and claims data from PCP or
endocrinologist MD/DO attesting that a patient is
a under care diabetic and whether they a been seen
with in 6 months to electronically attest. It
should be automated to do this. The world has
become electronic but we and they still have to
deal with "paper tiger." If we are ever going to
over come this we should look for a congressional
act to do so. It is a money saver! It's a limb
saver. It saves everyone time and money from the
DM/DO, government, intermediaries, patients and
yes even us. Common sense dictates this. We should
swing for the fences. We have podiatrists in
congress. Let's fund them. What about the
manufacturers? Wouldn't they be allies too?

George Jacobson, DPM, Hollywood, FL

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