As of November 2022, the National Supplier Clearinghouse ceased to exist and the DMEPOS enrolment was divided into two new enrollment carries NPE East (administered by Novitas) and NPE West (administered by Palmetto GBA-formerly NSC) . NPE East claims as its jurisdiction all DMEPOS providers East of the Mississippi (except the City of St. Louis) and NPE West claims its jurisdiction over enrollment of DMEPOS providers west of the Mississippi (except the City of St. Louis)
This change in enrollment carriers affects all DMEPOS providers, even if your interaction with Medicare patients for DMEPOS is very limited. That is, even if your Medicare DMEPOS claim submissions for custom foot orthotics are for claims rejection and/or for purposes of claims processing and forwarding to secondary insurance a vendor agreement (contract) is required.
The issue of having vendor contracts is nothing new, but it was rarely enforced. DMEPOS providers were always required to have a contract with a vendor who filled orders for DMEPOS which were not part of the providers’ regular inventory. That is if you did not as a regular manner of business stock an item, the Supplier Standards required you to have a contract to fill that order. This was rarely enforced and usually only at the time of a DMEPOS inspection. Now however, the two NPE contractors may now ask you to submit your vendor agreements (contract) at the time of revalidation or initial enrollment. The request to prove an existence of a contract is especially true for DMEPOS providers who provide DMEPOS from several product categories (e.g., orthotics of all types-custom fabricated, pre-fabricated OTS and pre-fabricated custom fit) as well as surgical dressings, diabetic shoes and inserts prefabricated and diabetic shoes and inserts (custom), etc.
For simplicity, custom fabricated items are routinely not stocked and are ordered by you on an as needed basis for a specific patient. Thus, for all custom fabricated items, such as custom fabricated foot orthotics, a vendor agreement is mandatory. For pre-fabricated OTS or custom fit items, the requirements are a bit less clear. However, for simplicity’s sake, our advice is to obtain vendor agreements (contracts) which will satisfy Medicare’s requirements. This agreement can be a one page simply written document.
