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 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 www.GPO.gov/fdsys/pkg/FR-2011-02-02/pdf/2011-1686.pdf.
