Legal

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Sunday, February 29, 2004

Supplier enrollment: How to do it right
With J. Everett Wilson

Q. I received a notice from my Medicare carrier for failing to provide accurate information on my supplier enrollment application. What are the penalties for this and how could I avoid them?

A. Medicare carriers are now regularly cross-checking the services and equipment that DMEs are providing to patients with the information provided in their supplier enrollment applications. The forms must include comprehensive information on the type of business and the products and services to be provided by a DME. If the products and services submitted to Medicare for reimbursement do not correspond with those listed in the form, carriers may deny the claims and possibly also revoke their provider number until the discrepancies are corrected. Providers who receive these notices must respond immediately by filing corrected enrollment information and requesting an appeal of the termination decision. Otherwise, they may lose their provider authorization and be required to re-apply for a new provider.

In addition, it is advisable for all DMEs to review the information that they provided on their enrollment form under the sections covering types of products and services to be furnished by the supplier. It is imperative that copies of all the required licenses for the services listed are included with the application. By ensuring the enrollment application lists all of the primary and secondary products and services that are provided by the supplier, DMEs may help to avert any potential problems regarding future discrepancies.

J. Everett Wilson, Esq., is managing partner at Wilson Suarez Lopez & Gennett: (305) 446-7300

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