ODs may have to comply with new CMS fingerprinting rule

Some ODs will have to comply with a new federal policy that requires fingerprinting for certain high-risk suppliers.

ODs enrolling in Medicare's Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) program for the first time will be categorized as "high risk" and will be subject to a new fingerprinting requirement. The policy does not apply to ODs already in the program.

The fingerprinting policy was an anti-fraud program established by the Affordable Care Act, according to Roger Jordan, O.D., chair of the AOA Federal Relations Committee. Under such a policy, "all new enrollees/suppliers will be classified as high risk and will remain there for their career—no matter how clean their reputation," he explains.

Any suppliers who enrolled in the DMEPOS program prior to the implementation of this policy are considered moderate risk, even if they re-enroll. This means they are not subject to the fingerprinting unless they engage in inappropriate activities, Dr. Jordan says.

Although eyeglasses are otherwise not covered in Medicare, post-cataract glasses are considered prosthetics—which is why OD suppliers are subject to DMEPOS requirements.

In a policy statement, CMS explains that Medicare Administrative Contractors will send out notification letters to applicable providers or suppliers on the fingerprinting requirement.

This will include contact information for a Fingerprint-Based Background Check Contractor (FBBC). ODs receiving such a letter would be required to contact the FBBC to find out where they get their fingerprints done. This can be accomplished electronically in certain locations, or by submitting an FD-258 form.

The policy is being phased in throughout 2014.  

Providers have 30 days to comply with the new fingerprinting requirements, Dr. Jordan notes. "Also, the cost of the fingerprinting will be borne by the doctor-supplier."

In its policy statement, CMS indicates that further investigation beyond the fingerprinting may be necessary, such as a background check. Any OD who wants to be a Medicare supplier must comply with the CMS policies related to background checks.

"A large inconvenience to meet"
In Dr. Jordan's view, it's unfortunate that the ophthalmic community has to participate in the new expanded requirements, given its history of low fraud. Even CMS has acknowledged that eyeglasses are not a fraud concern, he adds.  

Deadlines, a specific method to follow and cost will make this a large inconvenience for the profession to meet, he says. "This could definitely cause new enrollees to say no to the DMEPOS program when the letter requesting the fingerprinting arrives at the office."

The AOA believes the number of participating ODs in the DMEPOS program has declined because of increased fees and red tape required to retain the right to supply eyeglasses after cataract surgery.

May 14, 2014

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