CMS details new screening, application procedures

Thursday, March 3, 2011

BALTIMORE – As part of a new screening strategy, CMS will categorize newly-enrolling DMEPOS providers as high risk for fraud beginning March 25, the agency announced yesterday.

Screening procedures for high-risk providers will include all current screening measures, a site visit and, at a future date, a fingerprint-based criminal background check.

“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,” CMS stated in a release.

CMS will use three categories—limited, moderate and high risk—to determine the degree of screening that the Medicare Administrative Contractor (MAC) processing the enrollment application should perform.

The agency will categorize re-enrolling DMEPOS providers as moderate risk. Screening procedures for moderate-risk providers will include all current screening measures and a site visit.

Other providers in the high-risk category include newly-enrolling home health agencies (HHAs). Providers categorized as limited risk include physicians and skilled nursing facilities; providers categorized as moderate risk include independent diagnostic testing facilities and hospices.

CMS’s new screening strategy is required by the Affordable Care Act.

Also beginning March 25, CMS will require providers to submit a fee of $505 with their applications for Medicare enrollment. The fee will vary from year-to-year based on adjustments made to the consumer price index for urban areas (CPI-U). The fee does not apply to physicians, non-physician practitioners, physician organizations and non-physician organizations.

For more information on the new screening and application procedures, go to