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Increase in Medicare Provider Enrollment Site Visit Contractor Activity

As you may recall, in the CY 2023 Physician Fee Schedule final rule, CMS changed the provider enrollment risk level for SNFs from limited to high.  One of the requirements added was that all SNFs would be required to have a provider enrollment site visit contractor visit the SNF for a brief period to take some photos to verify the location existed and appeared to be operating as a SNF.  These Monday through Friday visits (no weekends or holidays) are unannounced. The contractor then sends the photos and a brief report to the Medicare Administrative Contractor (MAC) within a couple days to add to the provider’s enrollment file.

 

RESOURCES

AHCA Blog Article – June 21

CMS MLN Matters notice – June 20

 

CMS conducts authorized enrollment site visits to verify operational status. Site visit inspectors carry a photo ID and CMS-issued letter of authorization that you may review but not retain or copy. 

Enrollment site visits are conducted by our 2 Site Verification Services Contractors:

·         East: Palmetto GBA and its subcontractors:

o    Overland Solutions, Inc., an affiliate of EXL

o    Information Discovery Services

o    Compliance Review, Inc.

o    National Creditors Connection, Inc.

·         West: Deloitte Consulting, LLP and its subcontractors:

o    Nationwide Management Services, Inc.

o    CSI Companies, Inc.

o    Arthur Lawrence Management, LLC

o    Computer Evidence Specialists, LLC

More Information:

·         Medicare Provider Enrollment: Click on the Enrollment tab, and scroll to Step 3

·         Medicare Fee-for-Service Provider Enrollment Contact List (PDF): Contact your Medicare Administrative Contractor to verify that the site visit is valid

 

Medicare Program Integrity Manual Chapter 10 – Section 10.6.20 (excerpts below)

 

B. Provider and Supplier Types Other Than DMEPOS Suppliers and IDTFs

 

For provider/supplier types … that must undergo a site

visit pursuant to this section 10.6.20 and § 424.518, the SVC [site visit contractor] will perform such visits consistent

with the procedures in this section 10.6.20. This includes all of the following:

 

(1) Documenting the date and time of the visit, and including the name of the individual

attempting the visit.

 

(2) Photographing the provider/supplier’s business for inclusion in the provider/supplier’s

file. All photographs will be date/time stamped.

 

(3) Fully documenting observations made at the facility, which could include facts such as

(a) the facility was vacant and free of all furniture, (b) a notice of eviction or similar

documentation is posted at the facility, and (c) the space is now occupied by another

company.

 

(4) Writing a report of the findings regarding each site verification.

 

(5) Including a signed site visit report stating the facts and verifying the completion

of the site verification.

 

In terms of the extent of the visit, the SVC will determine whether the following criteria are met:

(i) the facility is open; (ii) personnel are at the facility; (iii) customers are at the facility (if

applicable to that provider or supplier type); and (iv) the facility appears to be operational. This

will require the site visitor(s) to enter the provider/supplier’s practice location/site rather than

simply conducting an external review.

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