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  • CMS Clarifies Scope of Onsite Visit

    The Centers for Medicare and Medicaid Services (CMS) recently released information regarding its new provider enrollment screening regulations, which contain a description of the scope of activities that contractors will perform during unannounced onsite visits to providers, including physical therapist practices. Physical therapists in private practice are not required to undergo site visits before they enroll in the Medicare program. However, they could be subject to unannounced site visits to ensure that providers are legitimate. Providers will be subject to requirements based on their assessed level of risk (limited, moderate, and high) as outlined in a new rule issued last month aimed at curbing fraud and abuse under Medicare, Medicaid, and the Children's Health Insurance Program.

    Specifically, a contractor's report for an unannounced site visit will document the date and time of the visit and observations made at the facility, such as the facility was vacant and free of all furniture, a notice of eviction or similar documentation is posted at the facility, or the space is occupied by another company. The contractor also will photograph the provider or supplier for inclusion in the provider's file. In terms of the extent of the visit, the contractor will determine whether the following criteria are met: the facility is open; personnel are at the facility; customers are at the facility (if applicable to that provider or supplier type); and the facility appears to be operational. This will require the site visitor(s) to enter the provider's practice or the supplier's site rather than simply conducting an external review. If any of the 4 elements listed above are not met, the provider's enrollment application may be denied or Medicare billing privileges revoked. 


    • I am closing my practice as of today, April 1, 2011. Am I required to notify CMS, and if so, how do I do that? I have searched the CMS website and have found no information. I do not want to cancel my medicare provider numbers at this time, but I am no longer going to be in private practice, but will be teaching and in an administrative role with no direct patient treatment.

      Posted by Thomas Gangemi on 4/1/2011 3:32 PM

    • I believe you have to notify them especially ask about the Medicare patient's files, what you should do? return them to medicare or keep them in a safe place?

      Posted by Tarek Hussein, Ph.D., P.T. on 4/6/2011 1:51 AM

    • What if I'm out of town with a meeting or something unlikely such as a vacation.

      Posted by Michael Reed on 4/8/2011 10:00 AM

    • How would this affect new applicants who want to provide services in the home under outpatient Medicare Part B? If a provider use their home address as their home office/practice location and provide services in the home, how would the provider know to be at their office location if these visits are unannounced?

      Posted by James Prussack -> >FV`BG on 6/9/2011 1:14 PM

    • can anyone give insight as to what goes on during the site visit? how long are they on site? do they go through charts? do they check equipment?

      Posted by mk on 12/31/2012 11:12 AM

    • Also curious, what do they do during the site visit? How should we prepare for this visit?

      Posted by Rebecca on 2/22/2013 6:26 PM

    • I am waiting for my letter to become a Medicaid provider in Florida. Can anyone tell me where can I find a list of facility requirements for Respite/Recreation Therapy?

      Posted by Marie Lim on 12/16/2016 6:19 PM

    • Could you ,please let me know when the on site visit will occur. I want to make sure that I am in my office ,with or without a patient. Thank you

      Posted by Anne-Marie J Deckx PT on 11/28/2017 8:57 PM

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