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The Compliance Team
Challenges of Selling Mail Order – Part I
by Lesa Merchant, Director of Field Operations, The Compliance Team, Inc., lmerchant@thecomplianceteam.org

Some common areas that are a challenge for mail order companies are: keeping up with out-of-state licensing requirements, keeping up with new licensing requirements, having patients comply with returning necessary patient paperwork, and ensuring patient understanding of instruction for use of the item or equipment received. Today’s discussion focuses on licensed personnel requirements. Subsequent newsletters will address other mail order concerns.

State Licensing

Orthotic braces are one of the more commonly shipped items. The type of brace, whether off-the-shelf, prefabricated (custom fitted) or custom fabricated, greatly affects whether the state requires a license and/or licensed personnel to dispense the brace.

The Palmetto GBA National Supplier Clearinghouse (NSC) licensure database (http://www.palmettogba.com/NSC) is an extensive database for Medicare licensure requirements and covers all states. This database should be reviewed for all states where shipping occurs.

It is also important to look at each relevant product category. Licensing requirements can vary, depending on whether the item is considered off-the-shelf, prefabricated (custom fitted), or custom fabricated. For instance, some states require that a licensed person (e.g., orthotist) dispenses braces, dependent on the category of brace.

It is essential to confirm via the DME Pricing, Data Analysis and Coding (PDAC) contractor (Noridian) website the full description of the Healthcare Common Procedure Coding System (HCPCS) codes being billed. Enter the HCPCS code into the look-up box. When the abbreviated description comes up, click on the HCPCS code and the long description will come up.

The description will specify whether the brace is off-the-shelf, prefabricated (custom fitted) or custom fabricated, and will also define whether the brace must be trimmed, bent, molded, assembled or otherwise customized to fit a specific patient by an individual with experience. This is an area of frequent misunderstanding and can have serious consequences with state and federal agencies.

The Compliance Team staff is always willing to guide our clients to the resources available for determining licensing needs; however, the state in question is the ultimate authority for licensing questions. Suppliers are fully responsible for researching and determining any state licenses or licensed personnel required for the products they dispense.

While braces are a commonly shipped item, any product category can have an associated licensing requirement, making it essential that you review the database for all specific items or equipment. It is also highly recommended that all suppliers sign up on the NSC List Serve service to receive notices regarding updated or new licensing requirements.

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