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DME Enrollment

I am very frustrated with the NPE enrollment process here in the eastern part of the country.

My colleagues in the west don't see to have this problem. Why is this such an issue when I thought Medicare was one unirform program?

1 comment

Comments (1)

Woodside DR

Jan 03

I will try and boil this down into the simplest of facts to help you understand why this has become a huge mess.

Medicare is a universal term covering many health care programs. These are administered by private or semi private companies who won a bid for those contracts.
The DME enrollment process used to be handled by one company, the National Supplier Clearinghouse (NSC). In the infinite wisdom of CMS and the Federal Gov't, that contract was split several years ago into two contractors. For the most part with some exceptions, those East of the Mississippi are relegated to enroll in DME with NPE E and those to the West of the Mississippi are enrollmed by NPE W. NPE W was the former NSC and is still staffed my many former NSC employees, including their head administrators and many others who simply transferred to the NPE W company. NPE E bid was won by Novitas, which had absolutely no experience in DME enrollment and minimal if any transplants went from the NSC to Novitas. Their bidding was underestimated for the costs and Novitas quickly realized they were over their heads. They initially failed to hire and train the right number of staffers.
The bottom line is that NPE W is running farily smooth, whereas NPE E enrollments are a mess. 200 plus days in limbo are not unusual.
To make matters worse the enrollment carriers are also saddled with EFT administration which previously was left to the DME MAC and many more providers (especially new ones) need fingerprinting. This requires yet the input of another carrier.
To make matters worse is that with all the DME fraud CMS has mandated more complex application process, designed to trip up fraudsters, hence preventing them from getting into the Medicare pool to being with.
Furthering the mess is that the enrollment carriers no longer employ or control the inspectors. With some inspectors being rogue and poortly trained, some suppliers are failing based on false information provided by these inspectors.
Failed applictions are no longer appealed to the contractor but are now required to be appeald via a Corrective Action Plan to yet another contractor.
So to say things are a mess, would be putting it mildly. Fortunately there are many of us out there who understand the mess and have the ability to resolve many of the issues facing providers either when re enrolling or when enrolling for the first time. Many providers make the mistake of handling these ever more complex applications themselves. Because they were able to previoulsy sneak through applications in the past they think they can do it again. But the application process has become more and more complicated. Thus I will say it again, it's worth its wt in gold to hire an expert who handles these applications daily! Not just in time but in your sparing yourself the costs of appealing poorly made decisions by government contactors.
Covid: Put a temporary hold on enrollment revalidations. But w/the PHE over, that backlog now has to be dealt with. And it is effecting processing times!

To sum up, yes it indeed is a mess. Fortunately I sit on a committee which meets with the enrollment carriers every quarter and I have their administrator's attention.

There is no expected time to clear this up, but the administrators do claim they are clearing up the backlog. I am not yet convinced of that!