Please read
URGENT
INFORMATION from OAA regarding
DMEPOS
(Durable
Medical Equipment Prosthetics and
Orthotics Suppliers) and the FTC "Red
Flags" Rule
Opticians Association of America
SURETY BOND INFORMATION
September 24, 2009
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| $50,000 SURETY BOND REQUIREMENT FOR MEDICARE BILLING PRIVILEGES |
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The Opticians Association of America (OAA) is very concerned and disappointed that opticians were not one of the professions exempted from the Surety Bond Requirement in order to maintain your Medicare Billing Status.
This decision has impacted opticians all over the country in a very negative way. OAA was not given any advance notice or warning of this unfortunate requirement. Though the OAA staff monitors all legislative activity regarding opticians, this ruling was not included in any legislative publications that we consistently review. OAA's notification finally came when our membership started receiving solicitations for the bond from insurance companies.
I want to ensure you that the Opticians Association of America is taking a very proactive stance in order to resolve this issue affecting so many of you.
The #1 priority right now is to assist opticians in finding a surety bond prior to the October 2, 2009 deadline in order to maintain your Medicare Billing Privileges. Information of obtaining the bond is listed below. |
| OPTICIANS ASSOCIATION OF AMERICA'S
PLAN OF ACTION
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Step 1: In a collaborative effort the Opticians Association of America and the Professional Opticians of Florida hired a Medicare specialist to investigate the options available to opticians to resolve this issue. However, changing federal requirements is a formidable and laborious task. OAA will keep you informed as information is received throughout this process.
Step 2: The Opticians Association of America has found a Surety Bond Broker that is licensed in all 50 States to help our members obtain the $50,000 Surety Bond at a reasonable fee prior to the October 2, 2009 deadline. The broker secured is LSJ Insurance Agency, Inc., who represents four certified bonding companies to ensure you receive the best price possible.
The rate OAA has been quoted is $250 for the $50,000 Surety Bond. LSJ Insurance Agency, Inc. requires that you complete a one page application (click here for the application) and they will need to pull your credit report in order to find the best rate you qualify for according to your credit history. Below is the contact information for LSJ Insurance Agency, Inc. (please contact the agency directly with any questions you may have):
Samir Jallad, President
LSJ Insurance Agency Inc
1353 Palmetto Ave., Ste., 100
Winter Park, FL 32789
P: 321-972-4863
F: 407-644-4423
E: SJallad@lsjins.com
Step 3: The Opticians Association of America is in the planning process for an all out legislative influence campaign to exempt opticians from this discriminatory ruling. OAA will be taking this issue up with our elected officials in Washington, DC.
A form letter is being prepared so that every optician in the U. S. will have the opportunity to send something directly to your elected officials. OAA is also requesting that you make an effort to schedule an appointment with your congressional delegation to explain how this requirement is crippling our industry and small businesses in general.
OAA will have an issue paper with talking points for your use when you visit with your elected officials. CapWiz (http://capwiz.com/oaa/dbq/officials/), OAA's online legislative tool can assist you in locating mailing addresses and contact information for all your congressional representatives. Once the letter to legislators and talking points are completed, both documents will be emailed to you and available on the OAA website (www.oaa.org).
Step 4: At the 2010 State Leadership Conference in January (21-23), the Opticians Association of America will be offering legislative breakout sessions in order to help inform you on the basics of influencing legislators both at the State and National level. As more and more healthcare legislation comes down from the Hill, opticians are going to need to be better informed and ready for action so please make plans to attend this extremely important conference. Registration materials are available at http://www.oaa.org/index.php?id=18. |
| UPDATE ON MEETING THE
MEDICARE DEADLINE
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| If you are required to obtain a Surety Bond and fail to do so, your optical dispensary will have its Medicare Supplier Number suspended and your claims for post-cataract eyeglasses will not be paid. You will then be required to re-apply for a new supplier number and any post-cataract eyeglasses dispensed until that number is issued cannot be billed to Medicare by you or the patient. |
| MEDICARE SURETY BOND SUMMARY |
Per final regulations implemented by CMS, DMEPOS suppliers will be required to become accredited to obtain and maintain Medicare billing privileges by October 1st of this year, others may be required to post a surety bond by October 2nd to secure Medicare billing privileges and most will be required to provide both.
Frank Whelan, the CMS agency administrator for the new requirements, informed the Opticians Association of America on September 9, 2009 that opticians are not exempt from the Medicare suppliers' surety bond requirement due Oct. 1st for DMEPOS. However, opticians are exempt from accreditation.
What you need to do if you are in the process of being accredited or obtaining a surety bond:
The Centers for Medicare & Medicaid Services (CMS) encourages all DMEPOS suppliers currently in the midst of the accreditation process to correct all outstanding deficiencies on your accreditation report, so that a site visit or accreditation decision can be rendered by the October 1, 2009 deadline. CMS also encourages all DMEPOS suppliers, subject to the bonding requirements, to obtain a surety bond.
While the DMEPOS Accrediting Organization will notify the National Supplier Clearinghouse (NSC) that you are accredited, you will need to notify the NSC that you have obtained your surety bond. When submitting your DMEPOS surety bond to the NSC, you should submit sections 1, 2A1, 12, and either 15 (if you are the authorized official) or 16 (if you are the delegated official) of the Medicare enrollment application (CMS-855S). By submitting the required sections of the CMS-855S, you will help to ensure that NSC is able to correctly associate your DMEPOS surety bond to your enrollment record.
Additional information regarding DMEPOS accreditation or the provisions associated with a surety bond, go to www.cms.hhs.gov/MedicareProviderSupEnroll.
Frequently Asked Questions (FAQs) on the surety bond requirement can be found on the NSC's FAQ page at www.palmettogba.com/nsc. |
| FREQUENTLY ASKED QUESTIONS |
Q. The applicable bond paperwork should be submitted along with: (1) Section 12 of the 03/09 version of the CMS-855S and (2) a signed and dated certification statement from that application. Links to those forms are listed below (A cover letter that explains the purpose of the submission is suggested, but not required.) If the supplier has multiple locations, it may submit one set of bond paperwork, one certification statement, etc., encompassing all of its locations.
A. The address to which the bond and associated CMS-855S paperwork should be sent is as follows:
National Supplier Clearinghouse
P.O. Box 100142
Columbia, SC 29202-3142
For the complete CMS-855S Application (39 pages) http://www.cms.hhs.gov/cmsforms/downloads/cms855s.pdf
Required Sections only 12 & 15 (5 pages) www.pof.org/cms855sSec12_Sec15.pdf
Q: Are non-participating ("non-par") DMEPOS suppliers subject to the bond requirement to the same extent as participating DMEPOS suppliers?
A: Yes. A DMEPOS supplier is not exempt from the bond requirement merely because it is "nonpar."
Q: How does an optometrist or ophthalmologist who dispenses eyeglasses qualify for the physician exemption?
A: An optometrist or ophthalmologist who dispenses eyeglasses can qualify for the physician exemption if the glasses are furnished only to his/her own patients as part of his/her own service. For purposes of this exemption, a "patient" is someone who, for instance, receives an eye exam or other diagnostic test from the physician prior to receiving the glasses. The term "patient" does not include, however, a person who walks into the physician's office with a prescription for glasses that was issued by another physician and simply receives the glasses without any sort of examination or test being furnished.
The same general principle applies to an enrolled optical center owned by an optometrist or ophthalmologist. The center can qualify for the physician exemption only if: (1) the shop and the physician's practice are under/within the same TIN and business structure (e.g., part of the same corporation), and (2) the glasses are furnished only to the optometrist/ophthalmologist's own patients as part of his/her own service. The term "patient," again, would not include a person who enters the optical center with a prescription for glasses that was issued by another physician and simply receives the glasses without any sort of examination or test being performed by the optical center.
In order to qualify as exempt from the Surety Bond requirement, the practice must provide post-cataract eyeglasses only to its own patients. 'Own patients' have been defined as those who receive some professional service from the physician in the practice prior to receiving the glasses.
What has not been clear in the past is that the optical dispensary must be part of the same business structure (e.g., corporation) and under the same tax ID number. This may be a problem for some dispensaries that have been set up as separate entities. |
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| Once again, please be assured that the Opticians Association of America will do everything possible to address this unfair requirement. |
| Opticians Association of America
4064 E Fir Hill Drive
Lakeland, Tennessee 38002
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Opticians
Association of
America
Legislative
Update -
September 2009
received 9-16-09 |
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DMEPOS
SURETY BOND -
OPTICIANS ARE NOT
EXEMPT |
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DMEPOS Surety Bond
and Accreditation
Requirement for
Medicare Billing
Privileges
Per final
regulations
implemented by CMS,
DMEPOS suppliers
will be required to
become accredited to
obtain and maintain
Medicare billing
privileges by
October 1st of this
year, others may be
required to post a
surety bond by
October 2nd to
secure Medicare
billing privileges
and most will be
required to provide
both.
Frank Whelan, the
CMS agency
administrator for
the new
requirements,
informed the
Opticians
Association of
America on September
9, 2009 that
opticians are not
exempt from the
Medicare suppliers'
surety bond
requirement
due Oct. 1st for
DMEPOS. However,
opticians are
exempt from
accreditation.
What you need to do
if you are in the
process of being
accredited or
obtaining a surety
bond:
The Centers for
Medicare & Medicaid
Services (CMS)
encourages all
DMEPOS suppliers
currently in the
midst of the
accreditation
process to correct
all outstanding
deficiencies on your
accreditation
report, so that a
site visit or
accreditation
decision can be
rendered by the
October 1, 2009
deadline. CMS also
encourages all
DMEPOS suppliers,
subject to the
bonding
requirements, to
obtain a surety
bond.
While the DMEPOS
Accrediting
Organization will
notify the National
Supplier
Clearinghouse (NSC)
that you are
accredited, you will
need to notify the
NSC that you have
obtained your surety
bond. When
submitting your
DMEPOS surety bond
to the NSC, you
should submit
sections 1, 2A1, 12,
and either 15 (if
you are the
authorized official)
or 16 (if you are
the delegated
official) of the
Medicare enrollment
application
(CMS-855S). By
submitting the
required sections of
the CMS-855S, you
will help to ensure
that NSC is able to
correctly associate
your DMEPOS surety
bond to your
enrollment record.
Frequently
Asked Questions (FAQs)
on the surety bond
requirement can be
found on the NSC's
FAQ page at
www.palmettogba.com/nsc.
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FTC "RED FLAGS" RULE |
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The "Red
Flags" Rule:
With identity
theft on the
rise in the
healthcare
industry the FTC
has mandated a
new rule to
protect you and
your customers.
WHO MUST COMPLY
according to the
Federal Trade
Commission?
Every
health care
organization and
practice must
review its
billing and
payment
procedures to
determine if
it's covered by
the Red Flags
Rule. Whether
the law applies
to you isn't
based on your
status as a
health care
provider, but
rather on
whether your
activities fall
within the law's
definition of
two key terms:
"creditor" and
"covered
account."
Creditor
Defined: Health
care providers
may be subject
to the Rule if
they are
"creditors."
Although you may
not think of
your practice as
a "creditor" in
the traditional
sense of a bank
or mortgage
company, the law
defines
"creditor" to
include any
entity that
regularly defers
payments for
goods or
services or
arranges for the
extension of
credit. For
example, you are
a creditor if
you regularly
bill patients
after the
completion of
services,
including for
the remainder of
medical fees not
reimbursed by
insurance.
Similarly,
health care
providers who
regularly allow
patients to set
up payment plans
after services
have been
rendered are
creditors under
the Rule. Health
care providers
are also
considered
creditors if
they help
patients get
credit from
other sources -
for example, if
they distribute
and process
applications for
credit accounts
tailored to the
health care
industry.
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On the
other hand,
health care
providers who
require payment
before or at the
time of service
are not
creditors under
the Red Flags
Rule. In
addition, if you
accept only
direct payment
from Medicaid or
similar programs
where the
patient has no
responsibility
for the fees,
you are not a
creditor. Simply
accepting credit
cards as a form
of payment at
the time of
service does not
make you a
creditor under
the Rule.
Covered
Account Defined:
The second key
term "covered
account," is
defined as a
consumer account
that allows
multiple
payments or
transactions or
any other
account with a
reasonably
foreseeable risk
of identity
theft. The
accounts you
open and
maintain for
your patients
are generally
"covered
accounts" under
the law. If your
organization or
practice is a
"creditor" with
"covered
accounts," you
must develop a
written
Identity Theft
Prevention
Program to
identify and
address the red
flags that could
indicate
identity theft
in those
accounts.
As a practical
matter, most
businesses and
organizations
that provide
products and
services to
their customers
and then bill
them later are
covered by the
Rule.
Note: If you're
covered by the
Rule, your
program must:
1.
Identify the
kinds of red
flags that are
relevant to your
practice
2.
Explain your
process for
detecting them
3.
Describe how
you'll respond
to red flags to
prevent and
mitigate
identity theft
4. Spell
out how you'll
keep your
program current.
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Christopher M. Allen
Executive
Director
Opticians
Association of
America
4064 E
Fir Hill Drive
Lakeland,
Tennessee 38002
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