The Compliance Landscape Is Shifting
If you’re a DMEPOS supplier, 2026 is not the year to fly on autopilot. Between new documentation requirements taking effect in April, expanded pre-payment audits, and the competitive bidding program gearing up for a 2028 restart, there’s a lot to track.
Here’s what matters most — and what to do about it.
New Documentation Requirements (Effective April 13, 2026)
Oxygen Gets the Face-to-Face Treatment
Starting April 13, oxygen equipment is officially added to the “Face-to-Face and Written Order Prior to Delivery” requirement list. That means you need both a qualifying face-to-face encounter and a complete written order on file before equipment goes out the door.
If your workflow doesn’t already catch this, now is the time to update it. Delivering before documentation is complete is one of the fastest ways to trigger a claim denial — or worse, an audit.
Prior Authorization Expansions
New HCPCS codes are being added to the required prior authorization list on the same April 13 date. If you haven’t recently reviewed which items in your catalog require prior auth, do it now. CMS also offers an exemption process for certain codes, but you have to proactively apply.
Refill Verification Is Non-Negotiable
CMS continues to strictly enforce the “Request for Refill” requirement. You cannot auto-ship supplies without verifying the patient’s ongoing need. Annual reminders to patients are mandatory. Skip this step and you’re looking at overpayment demands and potential fraud referrals.
What’s Triggering Audits Right Now
Medicare Administrative Contractors (MACs) are running Widespread Pre-Payment Service Specific Medical Record Reviews — and two categories are squarely in the crosshairs:
- Urological supplies — Widespread pre-payment reviews have been explicitly announced for 2026
- Oxygen concentrators (HCPCS E1390) — Currently under active pre-payment medical record review
If you supply either category, audit-proof your documentation now. Every claim should have a complete written order, face-to-face encounter documentation, proof of medical necessity, and a valid ABN on file.
The Compliance Checklist Every Supplier Should Review
Accreditation & Enrollment
- DMEPOS accreditation is current with a CMS-approved organization
- All NPIs have a $50,000 surety bond posted
- Business changes reported to CMS within 30 days (ownership, location, legal actions)
- Prescribing physicians are enrolled in Medicare
- Assignment accepted for all rental equipment claims
Documentation
- Face-to-face encounter documented before delivery (especially oxygen, effective April 13)
- Written orders complete with all required elements
- Prior authorization obtained where required
- Refill requests verified and documented annually
- Advance Beneficiary Notices (ABNs) current and properly executed
Coding & Billing
- HCPCS codes verified using MAC Coding Verification Tool
- Correct modifiers applied (note: nebulizer modifier requirements updated)
- Same/Similar Code Lookup used to prevent duplicate billing
- Claims cross-referenced against prior authorization requirements
HIPAA & Security
- PHI encrypted in transit and at rest
- Business Associate Agreements current with all vendors
- Staff HIPAA training completed annually
- Incident response plan documented and tested
Competitive Bidding: Where Things Stand
The DMEPOS Competitive Bidding Program is currently in a temporary gap — Round 2021 contracts for OTS back and knee braces expired December 31, 2023, and no new round is active yet.
However, CMS published a final rule in December 2025 with provisions to restart the program. The next round of competitive bidding is targeted for January 2028.
Meanwhile, industry groups including AAHomecare are actively advocating for delays — particularly for ostomy and urological supplies, with a congressional sign-on letter led by Rep. Chris Smith of New Jersey gaining traction in February 2026.
What this means for suppliers: You have roughly two years to prepare for the next bidding round. Use this window to strengthen your compliance infrastructure, optimize your cost structure, and build the documentation discipline that will matter when contracts are on the line.
How BG Clear Supports Your Compliance
We build compliance into every order — not as an afterthought, but as the foundation. Our process includes:
- Pre-verified Medicare eligibility checks
- Documentation review before claim submission
- PDAC coding verification
- Prior authorization support
- Competitive bidding compliance across all service areas
Questions about staying compliant in 2026? Talk to our team — we’re here to help you navigate the changes.