Are you an ophthalmologist considering adding a retail optical to your practice? Or, are you thinking of expanding your optometry practice’s services to include co-managing cataract surgeries? If so, ensure you properly register your dispensary as a durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) supplier for post-surgery eyewear.
Got DMEPOS Supplier Status?
Before you can bill Medicare for post-surgery eyewear, your dispensary must register and receive approval as a DMEPOS supplier. You might be thinking ‘I see Medicare patients all the time—I’m covered,’ and that’s understandable. The important distinction? Just because you are a Medicare provider doesn’t mean that you’ve registered your dispensary as a Medicare DMEPOS supplier.
For example, if you write a Medicare patient a prescription for post-cataract surgery eyewear and you haven’t registered your own practice’s dispensary as a DMEPOS supplier, that patient will have to either (a) pay for their eyewear out-of-pocket, or the more likely option (b) use their Medicare benefit elsewhere, like at one of your competitors’ practices or at a chain store. That’s a revenue-buster you’ll clearly want to avoid.
If you’re a DMEPOS supplier, you’re subject to a list of 30 supplier standards, according to the CMS 855S application. You must provide a copy of the standards to the patient and post them prominently in your optical. For more about the enrollment process and to review the CMS 855S enrollment application form, visit this page.
As a DMEPOS supplier, Medicare requires you to submit a physician order for the eyewear. “For any DMEPOS item to be covered by Medicare, the supplier must have an order from the treating physician before dispensing the item to the beneficiary,” Mary Pat Johnson, COMT, CPC, COE, CPMA advised attendees of a previous International Vision Expo West conference in Las Vegas. “Items dispensed without an order will be denied as not medically necessary by the DME MAC.”
To further comply with DME supplier policy, you’ll need to ensure that you have these four things in your records, says Krystin Keller, CPC, who spoke about optometric coding and billing at a previous year’s SECO conference:
- A written order for the glasses;
- Proof of delivery (i.e. the package tracking slip);
- The patient’s signature on the sales receipt confirming they received the eyewear. The receipt should include a detailed description of the items, such as brand names, model numbers, and quantity, advises Johnson.
- Indicate in the record that you provided the patient with a copy of the supplier standards, Keller notes, and ensure the patient signs the copy.
Done with DMEPOS?
If your practice is a registered DMEPOS supplier, then you should reassess your Medicare participation the same way you would evaluate your participation with any vision plan. Ask the hard question: Is all the complex compliance effort, the increased enforcement risk, and the cost in resources really worth it financially?
Medicare DME suppliers have been in the spotlight for fraud, particularly the wheelchair and power mobility suppliers. While Medicare hasn’t been specifically targeting optical, Medicare has tightened DME enforcement measures for all suppliers. Optical is now struggling with this issue, and some consultants have recommended, “Get out of DME Medicare. It’s not worth the hassle.”
The percentage of optical revenue attributable to Medicare reimbursement has declined, says Johnson. A significant number of patients only need readers, she adds, downsizing the need for more complex and more expensive eyewear. And consider the personnel costs, too. Practices are finding that it just isn’t cost effective to dedicate staffing time to DME billing and maintenance, Johnson adds.
If you decide to terminate, however, you can offer a low-cost eyewear option for your post-surgery patients, Johnson recommends. Just be aware that if you opt out, you must re-enroll as a new provider if you decide to participate in the future, advises Johnson.