DME CMS Site Visit Checklist
Based on 42 CFR § 424.57(c) Supplier Standards
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1
Licenses, Accreditation, and Legal Documents
All applicable federal, state, and local licenses and certifications must be current, valid, and clearly displayed.
2
Facility and Accessibility
The physical location must be accessible, clearly identified, and operational during posted business hours.
Facility is accessible to the public and ADA compliant
42 CFR § 424.57(c)(1, 7)
Hours of operation are clearly posted and visible
42 CFR § 424.57(c)(7)
3
Financial and Rental Agreements
All financial documentation, credit agreements, and rental or purchase option agreements must be maintained and available for review.
Credit agreements or invoices on file
42 CFR § 424.57(c)(4)
Capped rental, inexpensive, or routinely purchased item option agreements
42 CFR § 424.57(c)(5)
Proof of warranty coverage for all applicable items
42 CFR § 424.57(c)(6)
4
Beneficiary Documentation
Written materials, supplier standards, and ownership information must be provided and maintained for beneficiary transparency.
Written instructions and information on beneficiary use and maintenance of supplies
42 CFR § 424.57(c)(12)
Beneficiary copy of supplier standards (42 CFR § 424.57) available
42 CFR § 424.57(c)(16)
Listing of all management and owners, including name and title
42 CFR § 424.57(c)(17)
5
Complaint Resolution
A formal complaint resolution process must be established, documented, and accessible to all beneficiaries.
Complaint resolution protocol in place and documented
42 CFR § 424.57(c)(19)
Complaint log maintained and up to date
42 CFR § 424.57(c)(20)
6
Other Inspector-Requested Items
Additional items or documentation requested by the CMS site inspector during the visit.
Additional documentation or items as requested by inspector
Notes
Signatures
Supplier Representative — Signature
Date
Inspector — Signature
Date