New Medicare supplier requirements burden ODs

Despite strong opposition from AOA and other physician organizations, newly enrolling or re-enrolling physician suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) - including post-cataract eyeglasses - will face more rigorous screening and a $500+ application fee starting March 25 as a result of a new federal effort to crack down on health care fraud and abuse. For more information, read the latest from AOA News.

At this time, ODs do not need to take action. AOA members can choose to re-enroll prior to March 25 in order to preempt the need to pay the fee for several years. However, AOA warns that members run the risk that the re-enrollment process will be problematic. In general, AOA suggests that members wait to re-enroll until requested by the National Supplier Clearinghouse (NSC). Members choosing to enroll should be aware of the requirements to post a surety bond and/or to be accredited.

Despite the fact that nearly all physicians who supply DMEPOS to their patients are exempt from both the surety bond and accreditation requirements, Medicare will consider an optometrist to be a general medical equipment supplier subject to the surety bond and possibly additional requirements under certain conditions. During the DMEPOS enrollment process, the NSC has become known for asking optometrists about filling prescriptions written by other eye doctors.

Current Medicare policy requires that the eye doctor must do some sort of examination before providing eyeglasses, particularly if a new patient presents with a prescription, or else the doctor will be treated like a medical equipment company. ODs who do not wish to pay the surety bond should make sure their practice procedures follow the requirements specified by Medicare in FAQ #46 posted on the NSC website.

Optometrists who do not re-enroll when requested by the NSC will no longer be able to provide covered post-cataract eyeglasses to Medicare beneficiaries. Enrollment as a Medicare supplier is separate and unrelated to enrollment as a physician to provide professional services. An Advance Beneficiary Notice of Non-coverage (ABN) is required if a Medicare beneficiary is to be financially responsible for a statutorily non-covered item (including eyeglasses provided by a supplier who does not have a Medicare supplier number). To learn more, read Medicare's policy on ABNs.

AOA members with questions or concerns should contact the AOA Washington Office at: ImpactWashingtonDC@AOA.ORG.