07/31/2025    Paul Kesselman, DPM

Facility Accreditation and Surety Bonding

I've recently heard that Medicare in an attempt to
combat fraud is going to institute a yearly
facility accreditation and they have also started
cracking down on something I never heard of,
surety bonding. What is this, and as a DPM, do I
require this?

Response from thedoctorline.com: All physicians,
including DPMs are exempt from the Facility
Accreditation (FA) and Surety Bond (SB)
requirements. However, this exemption applies only
as long as you are providing the DMEPOS to your
own patients. Once you start filling Rx from other
doctors and that's all you are doing, you have
crossed the line and at that point you may be
subject to those FA and SB requirements. If
someone refers a patient for evaluation and
treatment of a disease or disorder and you
evaluate them, discuss treatment options (in other
words they are now your patient) and you are not
simply filling an Rx for something, then they are
your patient and you are exempt.

This has happened to me a myriad of times, where a
colleague does not provide custom AFOs and they
are referring the patient to me for a consult and
treatment. Hence the patient is now mine. I may
refer them back to the referring doctor for
ongoing treatment (RFC, etc), just as dentist
would refer someone to a periodontist for
endodontist and then refer them back for routine
dental matters.

In the DPM world, if I all I was doing was filling
an rx for a Cam Boot, that would require FA and
SB. The hassle for that is not worth it!


Now for the boring part and the resource where you
can fall asleep to all of this. This is buried in
the Medicare Improvement for Patients and
Providers Act of 2008. There is a wonderful chart
which has been derived from this regulation, which
summarizes all you need to know:

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extension://efaidnbmnnnibpcajpcglclefindmkaj/https
://dominoapps.palmettogba.com/palmetto/providers.n
sf/files/exemptionschartfinal.pdf/$FIle/exemptions
chartfinal.pdf

A simple explanation of FA and SB:

Facility Accreditation is a process by which a
third party (Not Medicare Inspection) requires you
to follow certain business standards of operation
buried in something call the Quality Standards.
There is a fairly hefty fee one must pay the
Accreditation Body for those who require it.
Currently Medicare mandates the Accreditation
agency inspect the facility on a triennial basis.
There is a recent push from three years to annual,
but that likely will not happen.

Surety Bonding (SB) is an insurance policy which
will pay an auditing agency in case your business
is in default and you owe the gov't agencies
money.

Again, DPMs are exempt from both FA and SB.

Basically, the regulation provides exemption from
Facility Accreditation for all physicians
(including DPMs) who are treating their own
patients and orthotists the latter who provide
custom orthoses).

The same exemption for SB applies to all
physicians and orthotists based on the summary
conditions.

Paul Kesselman,, DPM, Oceanside, NY




Additional coding and billing questions and
responses can be found at thedoctorline.com

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