CMS requires users to change their passwords every 60 days, and encourages users to take the certain additional actions to help protect their Medicare enrollment information. See Safeguard Your Identity and Privacy Using PECOS (PDF).
I’ve heard that CMS will use site visits as a screening activity to make sure only qualified providers and suppliers are enrolled. If I enroll in Medicare, could I be subject to a site visit?
According to CMS, a dentist who enrolls only to order and prescribe (i.e., using form CMS 855-O) will not be subject to such a site visit. However, a dentist who enrolls to bill Medicare (i.e., using form CMS 855-I) may be receive such a site visit.
The purpose of the site visit is to determine that the location identified by a provider on his or her application is open and operational. CMS will utilize its National Site Visit Contractor to perform these site visits. Results of the site visits are transmitted to CMS/MAC (Medicare Administrative Contractor) to take the appropriate action if the location is found to be non-operational (e.g., deactivation or revocation).
The site visits are only performed on billing providers. Providers that are enrolled solely to order and prescribe are not subject to these visits.
CMS announced in February, 2016 that increasing the number of such site visits is one of four tactics to reinforce screening activities aimed at protecting the integrity of the Medicare program and making sure only qualified providers and suppliers are enrolled. For more information, visit CMS, Strengthening Provider and Supplier Enrollment Screening, and CMS strengthens provider and supplier enrollment screening.
I’ve heard that CMS will deactivate the enrollment of certain providers who have not billed Medicare in the last 13 months. Does this apply to dentists?
Dentists should not be subject to deactivation for failure to bill, whether they enroll to bill Medicare (i.e., using form CMS 855-I) using or just to order and prescribe (i.e., using form CMS 855-O).
According to CMS, the purpose of the deactivation process is to deactivate providers who have not billed Medicare in a specified period of time but who may have failed to notify Medicare that they are no longer practicing or participating with Medicare. CMS will conduct an analysis before taking any action to deactivate a provider who hasn’t billed in 13 months. Specifically CMS checks whether that the provider is enrolled solely to order, refer, and prescribe or certain specialty types, e.g. pediatricians, dentists and mass immunizers (roster billers). These providers will be excluded from the deactivation actions. In addition, any provider deactivated will receive notification of this action from their Medicare Administrative Contractor (“MAC”). [PT4]