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Navigating regulatory requirements in healthcare and business compliance can be complex, but with a structured approach, you can ensure compliance while minimizing risk. Here are some key steps to help you navigate regulatory waters effectively.
Medicare Isn't The Only Game In Town!
Medicare Isn’t the Only Game in Town!
At Q-University’s virtual Learning Management System learn:
“Medicare Rule Books”
Accreditation support
Proper payer sequences
Engaging insurances
Commercial Insurances
Medicaid
Medicare Advantage Plans
Managed Care Org.
Hiring qualified personnel
Building DME to Healthcare Provider Relationships
Best marketing practices
Understanding Risks with Vendors
QPI is the only company to provide Virtual Administrator services. DME has been our specialty for thirty five years!
Access to QPI web portal – your virtual office
Daily, Weekly, Monthly, Bi-annual and Annual maintenance reporting
Comprehensive compliance management with H.A.R.P push technology
Accreditation management
Policies and procedures specific to accreditation standards
Responses to audits, inspections/ surveys
Corrective action plans
Ensure ongoing health of the companies PTAN’s, NPI’s
Nationwide State HME licensing
Credentialing application management for all payers
Corporate structure management
Human Resources program management
Risk Management activities required by payers
Performance improvement reporting
Sample Curriculum
Module 1 Introduction
Available in
days
days
after you enroll
Module 2 Administration: Corporate Structure
Available in
days
days
after you enroll
Module 2 Administration - Accreditation
Available in
days
days
after you enroll
Module 2 Administration - Policies and Procedures
Available in
days
days
after you enroll
- Why Are Policies & Procedures Important?
- Accreditation Compliance
- Regulatory & Medicare Compliance
- Operational Consistency & Training
- Continuous Improvement
- Section 1: General Compliance & Accreditation Alignment
- Section 2: Human Resources & Employee Training
- Section 3: Risk Management & Quality Control
- Section 4: Patient Experience & External Quality Control
- Section 5: Administrative & Operational Compliance
- Section 6: Updates Based on Recent Survey Findings
- Quiz: DME Provider Policies & Procedures Checklist
Module 2 Administration - CMS Supplier Standards
Available in
days
days
after you enroll
Module 2 Administration - CMS Quality Standards
Available in
days
days
after you enroll
- Summary of CMS DMEPOS Quality Standards
- Section I: Supplier Business Services Requirements
- B. Financial Management
- C. Human Resources Management
- D. Consumer Services
- E. Performance Management
- F. Product Safety
- G. Information Management
- Quiz: DMEPOS Supplier Standards outlined in 42 CFR 424.57
- Section II: Supplier Product-Specific Service Requirements
- B. Delivery & Setup
- C. Training & Instructions
- D. Follow-Up Services
- Quiz: Section II: Supplier Product-Specific Service Requirements of the DMEPOS Quality Standards
- Appendices: Respiratory
- Appendix B: Mobility Devices (Wheelchairs & Assistive Technology)
- Appendix C: Prosthetics, Orthotics, & Therapeutic Shoes
- Quiz: DMEPOS Quality Standards Appendices
Module 2 Administration - Purpose of the DMEPOS Supplier Manual
Available in
days
days
after you enroll
- Introduction
- CMS DMEPOS Jurisdiction C Winter 2025 Supplier Manual
- Supplier Enrollment & Compliance
- Supplier Documentation & Orders
- Billing & Claim Submission
- Medicare Coverage & Fee Schedules
- Medicare Secondary Payer (MSP) Rules
- Fraud & Abuse Prevention
- Appeals & Overpayments
- Resources & Education
- Quiz: DMEPOS Supplier Enrollment & Compliance
Module 2 Administration - DME Payer Sequence
Available in
days
days
after you enroll
- Introduction
- Understanding the Beneficiary 20% Co-Pay
- CMS Guidelines on Billing the 20% Co-Pay
- Policy on Not Sending Separate Statements to Patients
- Best Practices for Compliance
- Primary Payer (First to Bill)
- Secondary Payer (If Applicable)
- Tertiary Payer (If Applicable)
- DME Payer Sequence Illustrated Flowchart
Module 2 Administration - Introduction to Insurances
Available in
days
days
after you enroll
Module 2 Administration - Medicare A-B-C-D Explained
Available in
days
days
after you enroll
Module 2 Administration - Medicare Provider Enrollment - Part 1
Available in
days
days
after you enroll
Module 2 Administration - CEDI - Medicare Provider Enrollment - Part 2
Available in
days
days
after you enroll
- Step 1: Common Electronic Data Interchange (EDI) Transactions with NGS (National Government Services)
- Step 2: EDI Transaction Codes
- Step 3: Trading Partner ID
- Step 4: Crosswalk Your NPI to CEDI
- Step 5: Submit the CEDI NGS Submitter ID Application
- Step 6: Wait for Approval & Obtain Your Submitter ID
- Step 7: Complete Required Testing (If Applicable)
- Step 8: Start Submitting Claims via EDI
- Final Notes & Pro Tips:
- Supporting Documentation
Module 2 Administration - DMEPOS MAC Web Portals - Medicare Provider Enrollment Part 3
Available in
days
days
after you enroll
- DMEPOS Jurisdiction Web Portals & Provider Enrollment
- Key Functions Available on MAC Portals
- Step 1: Registering for DMEPOS Jurisdiction Web Portals
- Step 2: Gather Required Information
- Step 3: Register for a Provider Portal Account
- Step 4: Request Access to Portal Functions
- Step 5: Log In & Start Using the Portal
Module 2 Administration - Medicare Advantage Plans
Available in
days
days
after you enroll
- Introduction to Medicare Advantage Plans
- Steps to Ensure Reimbursement for Medicare Advantage Plans
- Reimbursement Challenges for Medicare Advantage Plans
- Best Practices for Success with Medicare Advantage Plans
- Enrollment Steps
- Credentialing and Contracting
- Managing Claims and Appeals for Medicare Advantage Plans
- Resources to Help with Enrollment and Claims
- Step 1: Introduction to Enroll with MAP’s Timeline
- Step 2: Credentialing & Contracting (Week 3-8)
- Step 3: Preparing for Patient Services (Week 9-12)
- Enrolling with Medicare Advantage Plans & Managing Claims
Module 2 Administration - Medicaid - Managed Care Organizations
Available in
days
days
after you enroll
- Introduction to Medicaid
- Understanding Medicaid Managed Care
- Step1: Enroll with a Medicaid MCO – State Medicaid License Required
- Step 2: Complete Medicaid Provider Enrollment
- Step 3: Credentialing & Contracting with the MCO
- Step 4: Verify Network Participation & Training
- Managing Claims & Compliance
- Quiz: Medicaid Managed Care Organization (MCO) Provider Enrollment
Module 2 Administration - In Network Commercial Insurance Carriers
Available in
days
days
after you enroll
Module 2 Administration - Introduction to Out of Network Insurance Carriers
Available in
days
days
after you enroll
Module 2 Administration - Insurance Enrollment Changes
Available in
days
days
after you enroll
Module 2 Administration - Competitive Bid
Available in
days
days
after you enroll
Module 3 Human Resources - Human Resources Department
Available in
days
days
after you enroll
- Introduction
- CMS Requirements for HR Records
- Accreditation Standards (ACHC, BOC, Joint Commission, etc.)
- State HME Licensing Requirements
- Licensed Providers (Pharmacists, Respiratory Therapists, etc.)
- Human Resources Department Checklist
- Background Checks & Compliance Training
- Provider Vaccination Requirements
- Quiz: CMS Requirements for HR Records & Compliance
- Bonus Lesson - Equipment Overview, Fee Schedules, Cost, ROI Video
Module 3 Human Resources - Job Descriptions
Available in
days
days
after you enroll
- DME Provider Job Descriptions: Importance & Key Roles
- Ensuring Compliance & Best Practices
- Essential DME Provider Job Descriptions
- Essential DME Provider Job Descriptions | Compliance Officer
- DME Technician
- Respiratory Therapist (if applicable)
- Customer Service Representative (CSR)
- Billing & Reimbursement Specialist
- Delivery Technician
- Warehouse/Inventory Manager
- Quiz: DME Provider Job Descriptions & Compliance
Module 3 Human Resources - DME Evaluation and Skills Assessments Examples
Available in
days
days
after you enroll
- DME Evaluations & Skills Assessments: Ensuring Competency and Compliance
- DME Technician Competency Checklist
- Respiratory Therapist (RT) Competency Checklist
- Customer Service Representative (CSR) Skills Assessment
- Billing & Reimbursement Specialist Assessment
- Warehouse/Inventory Manager Assessment
- Performance Evaluations & Competency Review Process
- Quiz: DME Evaluations & Skills Assessments
Module 3 Human Resources - DME Equipment Training
Available in
days
days
after you enroll
Module 4 Risk Management - Introduction to Risk Management
Available in
days
days
after you enroll
- Understanding Risk Management and DME Billing
- Regulatory Compliance
- Internal Controls and Fraud Prevention
- Patient Safety & Quality Assurance
- Financial Risk Mitigation
- Overview of DMEPOS Billing Process | Patient Eligibility Verification
- Patient File Documentation Requirements
- Claim Submission and Coding
- Denials, Appeals, and Audits
- Best Practices for Risk Reduction in Billing
Module 4 Risk Management - Medicare Fee Schedule
Available in
days
days
after you enroll
- Overview of the DMEPOS Medicare Fee Schedule
- Key Components of the DMEPOS Medicare Fee Schedule
- “Ceiling” and “Floor” Reimbursement Limits
- Payment Methodologies
- Rural vs. Non-Rural Reimbursement
- Beneficiary Cost-Sharing
- Adjustments & Annual Updates
- How to Access the DMEPOS Medicare Fee Schedule
- Quiz: DMEPOS Medicare Fee Schedule
Module 4 Risk Management - Billing - Local Coverage Determinations (LCD's)
Available in
days
days
after you enroll
Module 4 Risk Management - Pricing Data Analysis and Coding (PDAC)
Available in
days
days
after you enroll
Module 4 Risk Management - Billing - State License Directory
Available in
days
days
after you enroll
Module 4 Risk Management - Patient Eligibility
Available in
days
days
after you enroll
- How to Verify Patient Eligibility for DMEPOS Products and Services
- Step 1: Verify the Patient’s Insurance Coverage
- Step 2: Confirm HCPCS Code Coverage
- Step 3: Review Local Coverage Determinations (LCDs) & Medical Necessity
- Step 4: Check Prior Authorization & Documentation Requirements
- Step 5: Verify Patient Financial Responsibility
- Step 6: Document & Maintain Compliance Records
- Prevent Billing Issues with Pre-Verification
- Quiz: DMEPOS Patient Eligibility Verification
Module 4 Risk Management - Patient Documentation Requirements
Available in
days
days
after you enroll
- DMEPOS Patient Documentation Requirements & Supplier Responsibilities
- Key Documentation Requirements for DMEPOS Suppliers
- Required Documentation Before Claim Submission
- Advance Beneficiary Notice (ABN) – When to Issue
- Delivery and Pickup Documentation
- Backup Equipment Policy
- Supplier Record-Keeping Requirements
- DMEPOS Fee Schedules & Billing Rules
- Medicare Participating vs. Non-Participating Suppliers
- Quiz: DMEPOS Patient Documentation Requirements
Module 4 Risk Management - Patient Order Intake
Available in
days
days
after you enroll
- Patient Order Intake Form
- Patient Information
- Insurance Information
- Prescribing Licensed Independent Practitioner Information
- Equipment Ordered
- Insurance & Billing Verification
- Required Documentation Checklist
- Compliance & Documentation Requirements
- Use QPI Healthcare Services LLC’s Pre-Billing Checklist
- Quiz: Patient Order Intake Form
Module 4 Risk Management - Patient Pre Billing Checklist
Available in
days
days
after you enroll
- Pre-Billing Checklist
- Key Components of the Checklist
- Order Validation
- Medical Necessity & Documentation Compliance
- Competitive Bidding & Supplier Compliance (if applicable)
- Pre-Delivery & Billing Verification
- Proof of Delivery & Refill Requirements
- Compliance with Medicare Guidelines
- Quiz: Pre-Billing Checklist
Module 4 Risk Management - Patient Claim Development
Available in
days
days
after you enroll
Module 4 Risk Management - Provider Responsibilities - Fraud Waste and Abuse
Available in
days
days
after you enroll
Module 4 Risk Management - Provider Responsibilities -Incident Reporting
Available in
days
days
after you enroll
- CMS & Accreditation Organization Regulations on Incident Reporting
- Incident Report Supporting Documentation
- CMS Regulations on Incident Reporting
- Mandatory Reporting of Serious Incident
- Incident Investigation & Root Cause Analysis
- Incident Reporting System & Record Retention
- Reporting to CMS & State Agencies
- Accreditation Organization Requirements on Incident Reporting
- BOC (Board of Certification/Accreditation) Standards
- The Joint Commission (TJC) Standards
- Consequences of Non-Compliance with Incident Reporting Regulations
- Best Practices for CMS & Accreditation-Compliant Incident Reporting
- Quiz: CMS & Accreditation Organization Regulations on Incident Reporting
Module 4 Risk Management - Provider Responsibilities - Annual Performance Improvement Reporting
Available in
days
days
after you enroll
- DMEPOS Annual Performance Improvement Report
- Key Components of the Report
- Performance Measures (Ongoing Monitoring)
- DME Quality Review Numbers (Quality Assurance Checks)
- Patient Rights & Responsibilities / Patient Surveys (Patient Feedback Mechanism)
- Patient Abuse Reports / Patient Complaints & Grievances (Risk & Compliance Monitoring)
- Board of Directors (BOD) Meetings (Governance & Compliance Oversight)
- Importance of the Annual Performance Improvement Report
Module 4 Risk Management - Provider Responsibilities - Risk Management Activities
Available in
days
days
after you enroll
- Introduction to Risk Management Activities
- Billing & Coding Error Logs
- Emergency Drills & Fire Drills
- Facility Safety Inspections
- Hazard Vulnerability Analysis (HVA)
- HIPAA Assessments
- In-Service Training for Staff
- OSHA Assessment
- Patient Experience Surveys
- The Joint Commission - Root Cause Analysis (RCA) – Required for Sentinel Events
- Quiz: CMS Risk Management & Compliance
Module 5 Patient Outcomes - Building DME to Healthcare Provider Relationships
Available in
days
days
after you enroll
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