Dive Brief:
- In an effort to further protect and enhance the integrity of the Medicare program, CMS will be working harder ensure it utilizes only qualified providers and suppliers, Shantanu Agrawal, MD, CMS deputy administrator and director, Center for Program Integrity wrote in a blog post this week.
- Agrawal notes the ACA provided CMS tools to help better screen providers and suppliers and weed out those deemed most at risk for committing fraud.
- In addition to implementing those tools, Agrawal wrote, the CMS is strengthening its strategies around site visits to Medicare-enrolled providers and suppliers, improvements to its IT systems, and implementing continuous data monitoring to ensure accuracy of practice location data.
Dive Insight:
The blog post comes the same day CMS released its Medicare fee-for-service (FFS) provider and supplier lists for ground ambulance suppliers and home health agencies, as well as a list of the providers and suppliers currently approved to bill Medicare.
Agrawal's blog details four tactics being implemented to reinforce its screening activities:
- Increasing its site visits to Medicare-enrolled providers and suppliers to perform onsite reviews and verify enrollment information. "CMS has increased site visits, initially targeting those providers and suppliers receiving high reimbursements by Medicare that are located in high risk geographic areas," the blog notes.
- Enhancing technology to improve detection of vacant or invalid addresses and commercial mail reporting agencies (CMRAs).
- Deactivating providers and suppliers that have not billed Medicare for 13 months, excepting those from certain specialties and those enrolled specifically to order, refer, or prescribe.
- Checking addresses monthly against the U.S. Postal Service address verification database to help identify those that become vacant or non-operational after enrollment.