BALTIMORE — CMS announced last week that beginning March
25, newly enrolling and revalidating providers and suppliers will
be placed in one of three screening categories — limited,
moderate or high — representing their level of risk for
fraud. Newly enrolling DMEPOS suppliers have been assigned to the
high-risk group.
"The use of risk categories and associated screening levels will
help ensure that only legitimate providers and suppliers are
enrolled in Medicare, Medicaid and CHIP, and that only legitimate
claims are paid," according to a March 3 listserv notice.
The level of risk will determine the degree of screening to be
performed by the Medicare Administrative Contractor (MAC)
processing the enrollment application, the agency said.
Providers in the high-risk category will undergo all current
screening measures in addition to a site visit and, at a future
date, a fingerprint-based criminal background check.
Currently enrolled (revalidating) DMEPOS providers will be
designated a moderate risk. Screening for the moderate category
will include all current measures as well as a site visit.
The Affordable Care Act included a requirement for the screening
categories, and CMS published a
target="_blank">final rule in the Feb. 2 Federal
Register implementing the new system.
In addition to the screenings, the MACs will also begin
collecting a $505 application fee with certain enrollment
applications. The fee, which will vary from year to year based on
the CPI-U, does not apply to physicians, non-physician
practitioners, physician organizations and non-physician
organizations.
For more information, go to target="_blank">www.GPO.gov/fdsys/pkg/FR-2011-02-02/pdf/2011-1686.pdf.
