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Reminder: Optometrists subject to $500+ fee for Medicare DMEPOS enrollment

October 12, 2012

Optometrists who wish to provide eyeglasses for cataract patients under Medicare are subject to a new durable medical equipment prosthetics, orthotics and supplies (DMEPOS) registration fee every three years, according to the AOA Advocacy Group.  As reported in AOA publications previously, the fee was put in place in March 2011 over the objections of AOA and other physician organizations when the Centers for Medicare & Medicaid Services (CMS) decided to treat all DMEPOS suppliers as institutional fraud risks.

Under a government initiative to screen out unscrupulous providers, all physicians who are now enrolled as health care practitioners or suppliers under Medicare will be required to re-enroll by March, 2015.   Optometrists should watch for letters to revalidate their Medicare enrollment, which verifies their enrollment records in the government health plan’s Provider Enrollment, Chain and Ownership System (PECOS).

Optometrists and other health care physicians who wish to provide only professional services are not subject to any Medicare registration fees, the AOA Advocacy Group notes.

However, those who wish to provide health care products, including eyeglasses, are subject to a new $500+ fee ($523 this year, indexed to increase annually with inflation) as well as stringent new screening requirements including site visits by inspectors.

The Medicare DMEPOS registration fee is distinct from the health plan’s DMEPOS provider surely bond requirement, from which optometrists have been exempted unless they provide eyeglasses to the public without any sort of examination of the patient, and separate from the DMEPOS accreditation requirement, until the CMS decides to implement supplier standards for physicians.

The AOA Advocacy Group has been lobbying to win exemption for optometrists from the DMEPOS registration fee as well. However, at this time, the registration fee remains applicable to eyewear providers and other physicians who furnish DMEPOS to their patients, AOA Advocacy Group staff note.

Many optometrists have been receiving notifications to reenroll in Medicare over recent weeks, the AOA Advocacy Group reports.

For additional information, see “HHS anti-fraud program to mean new scrutiny, fees for physicians,” on the AOA News blog (http://newsfromaoa.org/2011/03/04/hhs-anti-fraud-program-to-mean-new-scrutiny-fees-for-physicians-2/) or the Medicare Learning Network article “Further Details on the Revalidation of Provider Enrollment Information” (https://www.cms.gov/MLNMattersArticles/downloads/SE1126.pdf).

2 comments

  1. Having reviewed the wording of the CMS documentation, it appears that individual physicians (as opposed to “institutional” entities) are not subject to the referenced fees. Please respond to this for the purpose of clarification of the following paragraph from the above summary: “However, those who wish to provide health care products, including eyeglasses, are subject to a new $500+ fee ($523 this year, indexed to increase annually with inflation) as well as stringent new screening requirements including site visits by inspectors.”


  2. Congress enacted the Medicare enrollment fee for all individuals and entities in Medicare, and, as the above post points out, the law exempts physicians from the fee. The CMS must not charge an enrollment fee to physicians, including optometrists, enrolling or re-enrolling to provide professional services (medical eye care) to Medicare patients. “Institutional” suppliers along with other entities (hospitals, nursing homes, etc.) are subject to the fee. However, in the regulatory process to implement the fee, the CMS made a controversial decision to define all DMEPOS suppliers, including physicians supplying DMEPOS to patients, as “institutional” suppliers. This new definition is not consistent with other regulatory definitions of DMEPOS suppliers, which recognized that some DMEPOS suppliers are physicians providing DMEPOS in their offices to patients rather than medical supply companies. Blaming the threat of fraud and abuse in the Medicare DMEPOS program, the CMS decided that all DMEPOS suppliers, even physicians, would be defined as “institutional” and treated as general medical supply companies. Unfortunately, this approach requires physicians to pay the enrollment fee to retain DMEPOS billing privileges.



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