Provider Enrollment with DME MAC for Indian Health Services (Rev. 1040, 09-11-06)

by  Jared Staheli
June 25th, 2015

All IHS providers and suppliers that do not currently have a supplier number and want to bill for DMEPOS items must enroll with the NSC.

Beginning July 1, 2005, IHS providers (including CAHs) and pharmacies were eligible to begin billing for DME. The NSC must accept enrollment applications from IHS and tribally operated hospitals (including CAHs) or hospital-based facilities and pharmacies providing DME beginning April 1, 2005.

All IHS facilities and pharmacies, whether operated by the IHS or a tribe, enrolled by the NSC, shall meet all required standards as set forth in 42 CFR 424.57. Compliance with the standards will be verified by the review procedures for all other DMEPOS suppliers except as discussed herein.

All IHS facilities and pharmacies, whether operated by the IHS or a tribe, shall be exempt from the comprehensive liability insurance requirements under 42 CFR 424.57(c)(10). All IHS facilities and pharmacies, whether operated by the IHS or a tribe, shall be exempt from the requirement to provide any State licenses for their facility/business. For example, if a DMEPOS supplier indicates on its application that it will be providing hospital beds and is located in a State that requires a bedding license, such license is not required. However, if they provide a DMEPOS item that requires a licensed professional in order to properly provide the item, they shall provide a copy of the professional license. The licensed professional may be licensed in any State or have a Federal license. For example, a pharmacy does not need a pharmacy license, but shall have a licensed pharmacist on staff.

Site visits shall be conducted for all facilities of the IHS enrolling as IHS suppliers. For enrollment purposes Medicare recognizes those facilities operated by the IHS and those facilities operated by the tribes.

The IHS enrollment shall be in accordance with the instructions provided for all DMEPOS suppliers on the Form CMS-855S, except for the following clarifications.

• Facilities operated by the IHS, including pharmacies are considered a Federal government organization. An Area Director of the IHS must sign the §15 Certification Statement of the Form CMS-855S, be listed in §6 of the form and sign the letter required by §5 of the form which attests that the IHS will be legally and financially responsible in the event that there is any outstanding debt owed to CMS.

• Facilities, including pharmacies that are tribally operated are considered tribal organizations. The §15 Certification Statement of the Form CMS-855S must be signed by a tribal official who meets the definition of an authorized official in accordance with the page 2 definitions shown on the Form CMS-855S. The same authorized official must be listed in §6 of the Form CMS-855S and must sign the letter required by §5 of the form which attests that the tribe will be legally and financially responsible in the event that there is any outstanding debt owed to CMS.

The CMS shall provide the NSC with a list of facilities of the IHS which distinguishes between IHS operated and tribally operated. On the list the NSC shall use the column entitled, “FAC OPERATED BY”, for this purpose.

Chapter 10 of Pub. 100-08, Medicare Program Integrity Manual contains additional information on the Form CMS-855S.

NOTE: Drugs furnished by tribally owned and operated facilities, including pharmacies that are covered under Medicare Parts A and B will continue to be covered and paid under the Medicare fee for service programs. Facilities shall continue to bill their carrier, FI and DME MAC for these drugs after the implementation of Medicare Part D.

References:

Provider Enrollment with DME MAC for Indian Health Services (Rev. 1040, 09-11-06). (2015, June 25). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/provider-enrollment-with-dme-mac-for-indian-health-services-rev-1040-09-11-06-26808.html

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