Turns out opthalmologists aren’t immune to the controversial new bonding requirements for DMEPOS suppliers.
There was some initial confusion about the Centers for Medicare & Medicaid Services’ (CMS) new regulation as it pertained to this niche. Aimed at curbing fraud and malpractice, the rule change requires DMEPOS suppliers to obtain a surety bond in order to continue billing Medicare after this fall.
After some uncertainty at the outset, it became clear that doctors who provide glasses or contracts to patients after cataract surgery were not exempt from the new requirements. And that had some physicians scrambling recently to meet the agency’s criteria.
According to a recent piece in Review of Ophthalmalogy, the $50,000 surety bond is required:
- If the optical shop is a separate corporation and has a separate tax ID from the doctor, the doctor’s practice or the group practice. This applies even if the optical is a second corporation that is physician-owned.
- If a patient comes in with a prescription after cataract surgery from an outside source, such as a referring physician. Unless this patient is your patient, i.e., has an exam or test done by your doctors, your optical has to be covered by a surety bond in order for you to fill the outside prescription utilizing the patient’s Medicare benefits.
- If you are enrolling as a Medicare DME supplier for the first time, an existing supplier undergoing a change of ownership, an existing supplier establishing a new practice location or reactivating/reenrolling a location, you are required to submit a surety bond.
Under the new requirements, it doesn’t matter if you participate in the program or not. Anyone who bills Medicare must adhere to the new standard.
Providers not in compliance have likely already heard from CMS. Those who fail to take appropriate action can lose their billing privileges for a year.
Image: House of Sims