Posts Tagged ‘deactivation’

Reactivation of Provider Number Requires Re-Certification Survey

Authored By: Todd J. Selby

On April 6, 2012, CMS issued a Survey and Certification Transmittal stating that when a Home Health Agency (“HHA”) deactivates its provider number (the provider number is now referred to as the CMS Certification Number or CCN), the HHA must be surveyed for compliance with the CMS Conditions of Participation (CoPs) for HHA’s if the HHA desires to reactivate its provider number.  Deactivation of a provider number generally occurs if the HHA does not file claims for 12 consecutive months.

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Update to Revalidation Enrollment Procedures

Authored By: Todd J. Selby

As an update to the previous post on the revalidation enrollment procedures it is important for hospices, home health agencies, and DMEPOS to know what level of screening they will receive from the Medicare Administrative Contractor (“MAC”).  In some instances these providers and suppliers will be screened at either a “high” or “moderate” level of risk by the MAC.  The risk category assigned corresponds with the amount of possible fraud and abuse that CMS believes is applicable to providers and suppliers.

All hospices (current and newly enrolled) will be screened at a “moderate” level of risk.  Newly enrolling home health agencies will be screened at a “high” level of risk.  The only other “high” category is newly enrolling DMEPOS.  DMEPOS or home health agencies that are publicly traded on the NYSE or NASDAQ are classified as “limited” risk.   Currently enrolled home health agencies and DMEPOS will be screened at a “moderate” level of risk.

It is VERY important that currently and newly enrolled hospices, home health agencies and DMEPOS accurately complete the revalidation process when completing the applicable CMS Form 855 due to the level of screening it will receive from the MAC.  It is also VERY important to know that the CMS Form 855 has recently changed and requires, in some instances, much more detailed information.  For example, the providers are required to provide much more detail on its ownership and operating structure.

Should you have questions on the revalidation process or the new CMS Form 855, please contact Todd Selby at 317.977.1440 or tselby@hallrender.com, Brian Jent at 317.977.1402 or bjent@hallrender.com, David Bufford at 502.568.9368 or dbufford@hallrender.com, or your regular Hall Render attorney.

Medicare Providers and Suppliers Must Begin Enrollment Revalidations

Authored By: David W. Bufford

As of March 2011, the Centers for Medicare & Medicaid Services (CMS) implemented new screening criteria in the Medicare provider/supplier enrollment process.  Newly enrolling and revalidating providers and suppliers are placed in one of three categories – limited, moderate, or high – each representing the level of risk to the Medicare program for that provider’s/supplier’s particular category.  The categorization will determine the degree of scrutiny the Medicare Administrative Contractor (MAC) will utilize when screening the enrollment application.    (more…)