Module 1 Introduction
Module 2 Administration: Corporate Structure
Module 2 Administration - Accreditation
Module 2 Administration - Policies and Procedures
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Why Are Policies & Procedures Important?
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Accreditation Compliance
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Regulatory & Medicare Compliance
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Operational Consistency & Training
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Continuous Improvement
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Section 1: General Compliance & Accreditation Alignment
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Section 2: Human Resources & Employee Training
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Section 3: Risk Management & Quality Control
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Section 4: Patient Experience & External Quality Control
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Section 5: Administrative & Operational Compliance
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Section 6: Updates Based on Recent Survey Findings
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Quiz: DME Provider Policies & Procedures Checklist
Module 2 Administration - CMS Supplier Standards
Module 2 Administration - CMS Quality Standards
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Summary of CMS DMEPOS Quality Standards
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Section I: Supplier Business Services Requirements
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B. Financial Management
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C. Human Resources Management
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D. Consumer Services
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E. Performance Management
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F. Product Safety
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G. Information Management
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Quiz: DMEPOS Supplier Standards outlined in 42 CFR 424.57
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Section II: Supplier Product-Specific Service Requirements
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B. Delivery & Setup
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C. Training & Instructions
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D. Follow-Up Services
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Quiz: Section II: Supplier Product-Specific Service Requirements of the DMEPOS Quality Standards
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Appendices: Respiratory
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Appendix B: Mobility Devices (Wheelchairs & Assistive Technology)
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Appendix C: Prosthetics, Orthotics, & Therapeutic Shoes
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Quiz: DMEPOS Quality Standards Appendices
Module 2 Administration - Purpose of the DMEPOS Supplier Manual
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Introduction
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CMS DMEPOS Jurisdiction C Winter 2025 Supplier Manual
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Supplier Enrollment & Compliance
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Supplier Documentation & Orders
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Billing & Claim Submission
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Medicare Coverage & Fee Schedules
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Medicare Secondary Payer (MSP) Rules
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Fraud & Abuse Prevention
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Appeals & Overpayments
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Resources & Education
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Quiz: DMEPOS Supplier Enrollment & Compliance
Module 2 Administration - DME Payer Sequence
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Introduction
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Understanding the Beneficiary 20% Co-Pay
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CMS Guidelines on Billing the 20% Co-Pay
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Policy on Not Sending Separate Statements to Patients
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Best Practices for Compliance
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Primary Payer (First to Bill)
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Secondary Payer (If Applicable)
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Tertiary Payer (If Applicable)
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DME Payer Sequence Illustrated Flowchart
Module 2 Administration - Introduction to Insurances
Module 2 Administration - Medicare A-B-C-D Explained
Module 2 Administration - Medicare Provider Enrollment - Part 1
Module 2 Administration - CEDI - Medicare Provider Enrollment - Part 2
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Step 1: Common Electronic Data Interchange (EDI) Transactions with NGS (National Government Services)
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Step 2: EDI Transaction Codes
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Step 3: Trading Partner ID
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Step 4: Crosswalk Your NPI to CEDI
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Step 5: Submit the CEDI NGS Submitter ID Application
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Step 6: Wait for Approval & Obtain Your Submitter ID
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Step 7: Complete Required Testing (If Applicable)
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Step 8: Start Submitting Claims via EDI
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Final Notes & Pro Tips:
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Supporting Documentation
Module 2 Administration - DMEPOS MAC Web Portals - Medicare Provider Enrollment Part 3
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DMEPOS Jurisdiction Web Portals & Provider Enrollment
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Key Functions Available on MAC Portals
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Step 1: Registering for DMEPOS Jurisdiction Web Portals
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Step 2: Gather Required Information
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Step 3: Register for a Provider Portal Account
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Step 4: Request Access to Portal Functions
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Step 5: Log In & Start Using the Portal
Module 2 Administration - Medicare Advantage Plans
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Introduction to Medicare Advantage Plans
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Steps to Ensure Reimbursement for Medicare Advantage Plans
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Reimbursement Challenges for Medicare Advantage Plans
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Best Practices for Success with Medicare Advantage Plans
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Enrollment Steps
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Credentialing and Contracting
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Managing Claims and Appeals for Medicare Advantage Plans
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Resources to Help with Enrollment and Claims
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Step 1: Introduction to Enroll with MAP’s Timeline
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Step 2: Credentialing & Contracting (Week 3-8)
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Step 3: Preparing for Patient Services (Week 9-12)
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Enrolling with Medicare Advantage Plans & Managing Claims
Module 2 Administration - Medicaid - Managed Care Organizations
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Introduction to Medicaid
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Understanding Medicaid Managed Care
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Step1: Enroll with a Medicaid MCO – State Medicaid License Required
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Step 2: Complete Medicaid Provider Enrollment
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Step 3: Credentialing & Contracting with the MCO
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Step 4: Verify Network Participation & Training
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Managing Claims & Compliance
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Quiz: Medicaid Managed Care Organization (MCO) Provider Enrollment
Module 2 Administration - In Network Commercial Insurance Carriers
Module 2 Administration - Introduction to Out of Network Insurance Carriers
Module 2 Administration - Insurance Enrollment Changes
Module 2 Administration - Competitive Bid
Module 3 Human Resources - Human Resources Department
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Introduction
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CMS Requirements for HR Records
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Accreditation Standards (ACHC, BOC, Joint Commission, etc.)
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State HME Licensing Requirements
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Licensed Providers (Pharmacists, Respiratory Therapists, etc.)
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Human Resources Department Checklist
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Background Checks & Compliance Training
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Provider Vaccination Requirements
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Quiz: CMS Requirements for HR Records & Compliance
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Bonus Lesson - Equipment Overview, Fee Schedules, Cost, ROI Video
Module 3 Human Resources - Job Descriptions
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DME Provider Job Descriptions: Importance & Key Roles
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Ensuring Compliance & Best Practices
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Essential DME Provider Job Descriptions
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Essential DME Provider Job Descriptions | Compliance Officer
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DME Technician
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Respiratory Therapist (if applicable)
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Customer Service Representative (CSR)
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Billing & Reimbursement Specialist
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Delivery Technician
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Warehouse/Inventory Manager
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Quiz: DME Provider Job Descriptions & Compliance
Module 3 Human Resources - DME Evaluation and Skills Assessments Examples
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DME Evaluations & Skills Assessments: Ensuring Competency and Compliance
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DME Technician Competency Checklist
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Respiratory Therapist (RT) Competency Checklist
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Customer Service Representative (CSR) Skills Assessment
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Billing & Reimbursement Specialist Assessment
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Warehouse/Inventory Manager Assessment
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Performance Evaluations & Competency Review Process
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Quiz: DME Evaluations & Skills Assessments
Module 3 Human Resources - DME Equipment Training
Module 4 Risk Management - Introduction to Risk Management
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Understanding Risk Management and DME Billing
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Regulatory Compliance
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Internal Controls and Fraud Prevention
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Patient Safety & Quality Assurance
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Financial Risk Mitigation
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Overview of DMEPOS Billing Process | Patient Eligibility Verification
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Patient File Documentation Requirements
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Claim Submission and Coding
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Denials, Appeals, and Audits
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Best Practices for Risk Reduction in Billing
Module 4 Risk Management - Medicare Fee Schedule
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Overview of the DMEPOS Medicare Fee Schedule
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Key Components of the DMEPOS Medicare Fee Schedule
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“Ceiling” and “Floor” Reimbursement Limits
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Payment Methodologies
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Rural vs. Non-Rural Reimbursement
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Beneficiary Cost-Sharing
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Adjustments & Annual Updates
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How to Access the DMEPOS Medicare Fee Schedule
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Quiz: DMEPOS Medicare Fee Schedule
Module 4 Risk Management - Billing - Local Coverage Determinations (LCD's)
Module 4 Risk Management - Pricing Data Analysis and Coding (PDAC)
Module 4 Risk Management - Billing - State License Directory
Module 4 Risk Management - Patient Eligibility
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How to Verify Patient Eligibility for DMEPOS Products and Services
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Step 1: Verify the Patient’s Insurance Coverage
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Step 2: Confirm HCPCS Code Coverage
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Step 3: Review Local Coverage Determinations (LCDs) & Medical Necessity
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Step 4: Check Prior Authorization & Documentation Requirements
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Step 5: Verify Patient Financial Responsibility
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Step 6: Document & Maintain Compliance Records
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Prevent Billing Issues with Pre-Verification
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Quiz: DMEPOS Patient Eligibility Verification
Module 4 Risk Management - Patient Documentation Requirements
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DMEPOS Patient Documentation Requirements & Supplier Responsibilities
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Key Documentation Requirements for DMEPOS Suppliers
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Required Documentation Before Claim Submission
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Advance Beneficiary Notice (ABN) – When to Issue
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Delivery and Pickup Documentation
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Backup Equipment Policy
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Supplier Record-Keeping Requirements
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DMEPOS Fee Schedules & Billing Rules
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Medicare Participating vs. Non-Participating Suppliers
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Quiz: DMEPOS Patient Documentation Requirements
Module 4 Risk Management - Patient Order Intake
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Patient Order Intake Form
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Patient Information
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Insurance Information
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Prescribing Licensed Independent Practitioner Information
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Equipment Ordered
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Insurance & Billing Verification
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Required Documentation Checklist
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Compliance & Documentation Requirements
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Use QPI Healthcare Services LLC’s Pre-Billing Checklist
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Quiz: Patient Order Intake Form
Module 4 Risk Management - Patient Pre Billing Checklist
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Pre-Billing Checklist
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Key Components of the Checklist
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Order Validation
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Medical Necessity & Documentation Compliance
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Competitive Bidding & Supplier Compliance (if applicable)
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Pre-Delivery & Billing Verification
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Proof of Delivery & Refill Requirements
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Compliance with Medicare Guidelines
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Quiz: Pre-Billing Checklist
Module 4 Risk Management - Patient Claim Development
Module 4 Risk Management - Provider Responsibilities - Fraud Waste and Abuse
Module 4 Risk Management - Provider Responsibilities -Incident Reporting
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CMS & Accreditation Organization Regulations on Incident Reporting
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Incident Report Supporting Documentation
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CMS Regulations on Incident Reporting
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Mandatory Reporting of Serious Incident
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Incident Investigation & Root Cause Analysis
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Incident Reporting System & Record Retention
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Reporting to CMS & State Agencies
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Accreditation Organization Requirements on Incident Reporting
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BOC (Board of Certification/Accreditation) Standards
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The Joint Commission (TJC) Standards
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Consequences of Non-Compliance with Incident Reporting Regulations
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Best Practices for CMS & Accreditation-Compliant Incident Reporting
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Quiz: CMS & Accreditation Organization Regulations on Incident Reporting
Module 4 Risk Management - Provider Responsibilities - Annual Performance Improvement Reporting
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DMEPOS Annual Performance Improvement Report
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Key Components of the Report
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Performance Measures (Ongoing Monitoring)
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DME Quality Review Numbers (Quality Assurance Checks)
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Patient Rights & Responsibilities / Patient Surveys (Patient Feedback Mechanism)
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Patient Abuse Reports / Patient Complaints & Grievances (Risk & Compliance Monitoring)
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Board of Directors (BOD) Meetings (Governance & Compliance Oversight)
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Importance of the Annual Performance Improvement Report
Module 4 Risk Management - Provider Responsibilities - Risk Management Activities
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Introduction to Risk Management Activities
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Billing & Coding Error Logs
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Emergency Drills & Fire Drills
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Facility Safety Inspections
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Hazard Vulnerability Analysis (HVA)
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HIPAA Assessments
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In-Service Training for Staff
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OSHA Assessment
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Patient Experience Surveys
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The Joint Commission - Root Cause Analysis (RCA) – Required for Sentinel Events
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Quiz: CMS Risk Management & Compliance
Module 5 Patient Outcomes - Building DME to Healthcare Provider Relationships
