Corporate Compliance

Ensure that your staff knows how to verify immigrant status

Compliance Monitor, July 13, 2005

Tip: Ensure that your staff knows how to verify immigrant status

Although CMS specifically states that a provider should not ask a patient whether he or she is an undocumented alien, a patient may voluntarily disclose this status, making the facility eligible for reimbursement under section 1011 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003. Otherwise, CMS requires providers to take the following steps:

1. Determine whether the patient is enrolled in or eligible for Medicaid. If yes, section 1011 reimbursement is not available.

2. Determine whether the patient has a border-crossing card or documentation for having been paroled into the United States. If so, reimbursement is likely. If the patient declines to answer this question or is unable to provide the correct paperwork, payment will not be available under this option.

3. Determine whether the patient reports a foreign place of birth and verifies eligibility by

  • supplying a foreign birth certificate, passport, voting card, expired visa, invalid border-crossing card, foreign driver's license, a "Matricular Consular" Mexican identification card, or other foreign identification card

  • supplying an invalid Social Security number

  • arriving in the custody of a government agent

    Providers are also required to seek all other possible payment options before applying for section 1011 reimbursement

    Editor's note: If you have a tip that you would like to share with your compliance peers, please send it to Compliance Monitor Editor Rebecca Griffin and we'll publish it in a future issue of Compliance Monitor.

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