(May 24, 2012): The Centers for Medicare & Medicaid Services (CMS) is rolling out a new survey initiative, known as the “National Site Visit Contractor” program. In updates to the Medicare Program Integrity Manual released on April 6, 2012 and April 13, 2012, CMS has somewhat quietly introduced the National Site Visit Contractor program, noting that the contractor handling this program will be responsible for performing site visit audits and surveys throughout the country for all providers except DMEPOS suppliers. In addition, CMS published additional information on the National Site Visit Contractor program on its website on April 25, 2012. CMS indicated that the National Site Visit Contractor will serve as “a screening mechanism to prevent questionable providers and suppliers from enrolling in the Medicare program.” (emphasis added). It further notes that the National Site Visit Contractor will collect information during each site visit from providers and verify enrollment. Notably, CMS also explicitly stated, “Failure to cooperate with the inspector(s) could result in the denial or revocation of your Medicare enrollment number.” (emphasis added). Providers should take note of this fact when the National Site Visit Contractor knocks on their door.
I. Who is the National Site Visit Contractor?
CMS has awarded the contract for this service to MSM Security Services, LLC, with subcontracts for Computer Evidence Specialists, LLC and Health Integrity, LLC. Some of you may have already dealt with Health Integrity and / or its auditors. Health Integrity serves as the Zone Program Integrity Contractor (ZPIC) for Texas, Oklahoma, Colorado, and New Mexico. It has recently audited a number of providers throughout Texas and Oklahoma, including home health agencies and DME suppliers. Over the years, our attorneys have represented numerous Texas and Oklahoma health care providers whose practices and / or organizations have been audited by this ZPIC. Health Integrity audits are serious business. If you are ever audited by Health Integrity or another ZPIC, it will be essential for you to show that your business operations and coding and billing practices fully comply with CMS regulations and any Local Coverage Determination (LCD) mandates issued by the Medicare Administrative Contractor responsible for processing claims in your area of the country.
II. How Should You Respond if Your Organization is Subjected to an Unannounced Site Visit?
It is important to keep in mind that the site visit contractors and subcontractors who will be serving as National Site Visit Contractors are knowledgeable, aggressive and experienced in auditing and surveying the business practices and coding and billing efforts of healthcare providers. They will expect cooperation when on-site, and will probably leave no stone unturned when reviewing a facility to determine if a provider should remain admitted (or be admitted) as a participating provider in the Medicare program. Therefore, you should ensure that your organization has an effective compliance plan in place and it is actively being followed. While CMS has not released its “pre-defined” list of issues that will be examined by site visit contractors, you should expect the contractors to examine any and all risk areas that may be present in your organization, not limited to merely coding and billing practices. The National Site Visit Contractor will probably want to look at your existing and potential business relationships, referral sources, and the licensure status of your staff (if applicable). Should the site visit contractor find that you are employing an excluded person, you should expect to face significant penalties. The “best practice” for your organization would be to conduct a gap analysis of your organization’s coding and billing practices and all of your business arrangements and relationships. Do it now – before you are rejected or removed from Medicare.
Robert W. Liles is a Managing Member in the Washington, D.C. office of Liles Parker. He is experienced in conducting gap analyses of healthcare facilities, developing and implementing effective compliance plans, and providing training to staff on fraud, abuse, and compliance issues. For a free consultation, call Mr. Liles today at: 1 (800) 475-1906.