Medicare supplier program requires fingerprint-based background checks

February 23, 2016
Some practitioners might find the application process and the fees “burdensome.”

A federal screening policy that requires some doctors of optometry to undergo fingerprint-based background checks still raises occasional eyebrows two years after it launched as part of the Affordable Care Act.

The screening, designed to thwart fraud, affects doctors of optometry who newly enroll in Medicare's Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) program, plus some physicians previously disenrolled. Doctors of optometry enroll as DMEPOS suppliers because Medicare-covered post-cataract glasses are considered prosthetics.

Starting in 2014, Medicare phased in a program that classified all new supplier enrollees in DMEPOS as "high risk" regardless of whether they had done anything to deserve the designation. Further, some currently enrolled suppliers are moved into the "high-risk" category if they previously had legal problems in the program.

Doctors of optometry are notified of the fingerprint requirement, which they are responsible for paying, in a letter from their Medicare administrative contractor. The AOA has learned of a very small number of doctors of optometry who are current suppliers and were required to submit fingerprints.

If a doctor gets such a letter, he or she must follow through in 30 days. Otherwise he or she can't participate in the DEMPOS program, says Roger Jordan, O.D., chair of the AOA's Federal Relations Committee.

Dr. Jordan participates in DEMPOS. Yet, he has his reservations regarding the program.

The application process and the fees associated with the program are "burdensome" for practitioners, Dr. Jordan says. He cited an enrollment fee ($544 in 2016) plus the costs of the fingerprints. These costs are borne by physicians, at a time when technological advances are making prescriptions for cataract glasses increasingly unnecessary. "Cataract surgery and the products are getting better and better," Dr. Jordan says.

A service to patients

Some doctors of optometry might decide to drop the service, considering the effort required versus the return. If doctors don't sign up for the program, he says, patients might have to choose between seeking out another provider to write their prescriptions and paying the costs out of pocket.

Dr. Jordan continues to offer the service though.

"It's a service to my patients," he says.

Here are some other tips for physicians considering their participation in the DEMPOS program:

  • Enrolling or revalidating as a DMEPOS supplier is more likely to include a site visit. Doctors might want to report their hours are "by appointment only" for post-cataract glasses to ensure they will be open when inspectors arrive.
  • Doctors who are deactivated for not billing in 13 months, or for declining to pay the enrollment fee to revalidate, may be considered "high risk" in the future subject to fingerprinting. If you want to stop being a supplier, talk to the National Supplier Clearinghouse to follow the recommended process.
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