Tag: Compliance
Compliance: Implement a pre-billing review
October 6, 2026Cheryl Henninger
Q. What documentation should be in place before a DME claim is submitted?
A. A DME claim should not reach billing until the patient file already supports the item ordered, the patient’s eligibility and medical need, and the provider’s compliant delivery of service.
Start with the order. It should be complete, signed and specific enough for the item and accessories being billed. Then review the medical record to confirm it supports the diagnosis, coverage criteria and continued need....
Ventilation: Embrace your inner expert
October 6, 2026Boone Lockard
Q: With the new ventilation NCD placing greater emphasis on clinical involvement, how should providers think about reimbursement and their relationships with referral sources moving forward?
A: The new NCD is changing more than reimbursement requirements. It's changing how providers are viewed within the patient care continuum.
Historically, some referral sources may have viewed the provider's role as largely transactional: delivering equipment, providing setup and managing fulfillment....
Moratorium ends, but spotlight on enrollment and compliance continues
October 2, 2026Theresa Flaherty
YARMOUTH, Maine – The home medical equipment (HME) industry welcomed the end of a six-month moratorium on new provider enrollments on Aug. 27, but providers shouldn't mistake that move for a broader easing of regulatory oversight, says Jamie Davis, a health care compliance attorney and owner of Cornerstone Medical Supply.
In September, the Centers for Medicare & Medicaid Services (CMS) announced a new one-year probationary period that will require newly enrolled providers and those undergoing...
Compliance: Put billing, accreditation into same silo
September 9, 2026Cheryl Henninger
Q. How can DME providers better align billing documentation with accreditation readiness?
A. The first step is to stop treating billing compliance and accreditation compliance as two separate jobs. In a strong DME operation, they should be looking at the same patient story from two different angles.
Billing asks: Do we have what we need to support medical necessity, coverage, coding, modifiers, continued need and delivery? Accreditation asks: Did we follow our policies, educate the patient,...
Legal: Take steps now to update compliance
September 9, 2026Kianna Sitarski
Q. How can DMEPOS suppliers prepare for new compliance requirements that may arise from the CRUSH Request for Information?
A. In early 2026, CMS issued a Request for Information (RFI) to solicit recommendations and information from industry participants and other stakeholders to bolster the Trump administration’s Comprehensive Regulations to Uncover Suspicious Healthcare (“CRUSH”) initiative. The CRUSH RFI sought input “…on ways to strengthen CMS’s ability...
Accreditation stakes are high under new rule
June 26, 2026Liz Beaulieu, Editor
WATERLOO, Iowa – A new accreditation guide from VGM & Associates and the Healthcare Quality Association on Accreditation (HQAA) is well-timed, with reports of home medical equipment (HME) providers falling short in their resurveys under a new Medicare rule that requires 100% compliance on all standards starting this year.
Depending on their accreditation timeline, providers who fail to meet the standard risk a lapse in accreditation followed by a temporary revocation of their provider transaction...
VGM guide provides clear path to accreditation readiness
June 15, 2026HME News Staff
WATERLOO, Iowa – VGM & Associates has released a comprehensive accreditation guide, a practical, all-in-one resource designed to help VGM members streamline accreditation preparation and build a more consistent, repeatable approach to compliance. Developed in partnership with the Healthcare Quality Association on Accreditation (HQAA), the guide provides step-by-step guidance across the full accreditation cycle – from pre-survey preparation to accreditation day and post-visit corrections...
BOC appoints compliance lead
July 28, 2025HME News Staff
OWINGS MILLS, Md. - The Board of Certification/Accreditation (BOC) has appointed Tina Culbreth, CHC, CCEP, CHPC, CDME, as director of compliance to oversee its compliance and accreditation operations. In this role, she will provide strategic oversight of business activities like accreditation eligibility reviews, corrective action processes and surveyor communications. She will also collaborate with internal teams and stakeholders to enhance process efficiency and ensure alignment with CMS requirements...
Medtrade preview: Dive into e-commerce – compliantly
January 24, 2025Theresa Flaherty
DALLAS – When it comes to launching an e-commerce site, Medtrade speaker Cassi Price sees a lot of hesitation from HME providers who don’t understand how they can do it compliantly.
Price, president of VGM Forbin, says she wants to pull back the curtain on best practices during her session, “Navigating Compliance in Ecommerce: A Roadmap for Online Retail Success in the Healthcare Industry,” which she will co-present with Kelly Grahovac of the van Halem Group.
HME...
Billing: Invest in compliance
November 13, 2024Kit Shellhouse
Q. What steps can I take to prepare for audits under managed care contracts?
By Kit Shellhouse
A. As a provider, preparing for audits under managed care contracts can be a chore, but the key is to understand the requirements and expectations well in advance. Invest time in reviewing your managed care contracts to grasp all requirements, including billing procedures, documentation standards and compliance obligations. This foundational knowledge is crucial for staying well-informed...