Industry News

CMS Implements New Risk Based Enrollment Screening Process.

The Centers for Medicare & Medicaid Services (CMS) recently implemented a new, risk-based screening system to process provider and supplier Medicare enrollment applications. According to CMS, each new provider or supplier that applies to enroll in the Medicare program is assigned a risk level (limited, moderate or high) that corresponds with their potential to commit fraud, waste or abuse. Providers and suppliers in the “limited” risk category will undergo screening procedures similar to those already in use. Those in the “moderate” risk category must pass current screening measures and undergo a site visit. Those in the “high” risk category are subject to more rigid screening procedures, including license verification, database checks, fingerprinting, criminal background checks and site visits. Providers and suppliers that are initially enrolling in Medicare, adding a location or revalidating their enrollment information must also submit an application fee. This application fee does not apply to physicians, non-physician practitioners, physician group practices and non-physician group practices, unless they are applying to enroll as a durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) supplier The fee for March 25, 2011 through December 31, 2011 is $505.00. The Centers for Medicare & Medicaid Services. “Implementation of Provider Enrollment Provisions in CMS-6028-FC.” MLN Matters MM7350. 23 Mar. 2011.