DME Accreditation & Credentialing FAQ
From Setup to Billing: Your Roadmap to DME Accreditation & Credentialing Success
1. Do all DME suppliers need accreditation?
Any organization or provider that wants to bill Medicare Part B as a DMEPOS supplier must obtain accreditation.
- Accreditation required: Physicians, NPs, dentists, PTs, and facilities enrolling as DMEPOS suppliers
- Not required: Practitioners providing limited supplies incident-to patient care (e.g., canes, walkers, dressings) and billing under their own NPI
2. Which provider and facility types require accreditation?
Accreditation applies to:
- Providers: Physicians, Nurse Practitioners, Dentists, Physical Therapists
- Facilities: Ambulatory Surgical Centers (ASCs), FQHCs, hospitals, etc.
Exemptions: Practitioner-owned offices that only furnish limited items directly to their own patients (without operating as a supplier).
3. What staff training is required for accreditation?
Staff must be competent and trained on each DME item supplied. Training includes:
- Vendor or manufacturer in-services
- Internal competency testing
- Documented patient instruction
Competency is measured by skill validation, not fixed training hours. The training covers how to safely use, set up, maintain, and educate patients on specific equipment. These sessions serve as proof that your staff is competent and properly trained on the DME items you dispense.
See examples below:
CPAP / BiPAP Vendor: Vendor provides training on device operation, humidifier attachments, mask fitting, and cleaning protocols
Wheelchair Vendor: Vendor trains staff on folding, adjusting seat width/height, and maintenance
Oxygen Supplier: A gas vendor provides instruction on cylinder storage, concentrator setup, and oxygen safety
Accreditor surveyors example questions include:
- “Show me your staff competency file”
- “Do you have vendor in-service certificates for CPAP training?”
4. What is a Surety Bond and when is it required?
- Medicare requires a $50,000 surety bond per NPI and per location
- Protects Medicare against fraudulent billing and overpayments
- Exceptions: Limited physician-supplied incident-to items
- High-risk suppliers (with fraud findings or sanctions) may require additional bonds
5. How do malpractice insurance, liability coverage, and surety bonds differ?
- Malpractice Insurance: Protects providers against patient negligence claims
- General Liability Insurance: Protects the business against accidents, property damage, or slip-and-fall claims.
- Surety Bond: Protects Medicare and payers by guaranteeing refunds for billing errors, fraudulent claims or overpayments.
6. What’s the difference between CMS-855s and CMS-855i?
- CMS-855s: Supplier application for DMEPOS (required for accreditation, surety bond, and site inspections).
- CMS-855i: Individual provider enrollment (used for physician billing, not DME supplies).
- Many practices complete both forms: one for clinical services (855i), one for DME supplier enrollment (855s).
7. Which accreditation agencies does CMS approve?
CMS recognizes multiple accrediting bodies, including:
- ACHC – consultative, strong in home health/DME
- CHAP – compliance-driven, detail-focused
- TJC – highly recognized, hospital/ASC aligned
- HQAA – focused on DME, streamlined approach
- BOC – strong in orthotics/prosthetics and DME add-ons
Note:
ACHC – Accreditation Commission for Health Care
CHAP – Community Health Accreditation Partner
TJC – The Joint Commission
HQAA – Healthcare Quality Association on Accreditation
BOC – Board of Certification/Accreditation
8. Physician-Owned vs. Non-Physician-Owned DMEs?
- Physician-Owned: May provide limited supplies without accreditation if incident-to patient care
- Non-Physician-Owned: Always requires accreditation to bill Medicare
- Both require accreditation if operating as a full DMEPOS supplier
9. Are there exceptions to DME accreditation?
Yes, but they are narrow:
- Practitioners furnishing only minimal items incident-to care
- Pharmacies in specific scenarios
Most DME suppliers still require full accreditation.
10. What happens when a DME supplier expands the scope of supplies after initial accreditation?
When a DME supplier first get accredited, the accreditation certificate is tied to specific DME product/service categories (e.g., mobility aids, respiratory equipment, diabetic supplies). If new product lines are added later, the DME supplier must inform the accrediting organization and go through a structured process and receive updated accreditation certificate. The time to obtain accreditation for expanded supplies depends on whether the scope is minor or major in nature.
- Accreditation initially covers only the categories approved at enrollment
- Adding new supply categories requires:
- Updating the accrediting body
- Filing changes with CMS (855s)
- Updating state licenses (if applicable)
- Some accreditors require a mid-cycle survey before approval
- A DME supplier cannot bill for new items until approval is granted
11. Medicare vs. Commercial Payer Credentialing?
- Medicare: Requires accreditation, surety bond, site inspection, and CMS-855s
- Commercial Payers: Often mirror Medicare but may vary:
- Some specify approved accrediting bodies
- Some require higher liability insurance coverage
12. Timeline for DME Setup, Medicare Enrollment & Billing
The process typically takes 6–9 months from start to first claim submission:
- Form business entity & secure physical location
- Obtain surety bond
- Prepare policies & staff training
- Undergo accreditation survey
- Submit CMS-855s with accreditation & bond
- Apply for state DME licenses (where required)
- Apply to commercial payers after Medicare approval
Generally, states list proof of accreditation as part of the license application documentation. Some states allow a state license application before full accreditation, provided you show documentation that accreditation is underway. Whereas some states do not require DME licensing for certain supplies. You must check your state regulations for DME licensing.
13. What are the physical location, signage, and hours requirements?
- Must have a real, staffed office (no P.O. Boxes, UPS boxes, or virtual offices)
- Must display permanent signage
- Must maintain posted business hours
- DME site is subject to CMS or NSC site inspections
14. What if there is no physical location?
- Accreditation and CMS enrollment cannot be approved without a physical, staffed office
- Mobile, virtual, or home-only locations are not allowed
15. Can one owner operate multiple DME locations?
Yes, but each location requires:
- A separate surety bond
- A separate accreditation survey
- A separate CMS-855s enrollment
Medicare treats each site as an independent DME supplier.
Conclusion
For healthcare providers and DME suppliers, accreditation, surety bonds, and proper Medicare credentialing are the essential building blocks of participation in the Medicare program. Meeting these requirements ensures compliance, protects reimbursement, and positions your organization for long-term success.
At TriumpHealth, we take the complexity out of DME enrollment and compliance. From accreditation readiness and surety bond setup to CMS-855S filing and commercial payer credentialing, our experts provide end-to-end support so you can focus on patient care while we manage the regulatory details. Schedule A Consultation with TriumpHealth DME experts today. You can also contact us via email [email protected] or phone (888) 747-3838 x0
Disclaimer:
The content provided by TriumpHealth is for informational purposes only and does not constitute legal, medical, or financial advice. Regulations and payer requirements may change; please consult a qualified professional for guidance specific to your situation. Click here to review our full legal disclaimer.
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