Home Health & Hospice

Homecare Providers Now Subject To New Risk Screening Criteria

Homecare Insider, August 22, 2011

According to the Centers for Medicare and Medicaid Services (CMS), homecare providers who enrolled in the Medicare program prior to March 25, 2011, must revalidate their enrollment under the new risk screening criteria that is required by the Affordable Care Act (ACA). Newer providers, those who enrolled after that date, have already been subjected to this screening criterion.

The new screening criteria, part of CMS’ continued effort to reduce fraud, waste, and abuse, involves three screening categories: limited, moderate, or high. Each of these categories represents the level of risk to the Medicare program and the degree of screening to be performed by the Medicare Administrative Contractor (MAC) who processes the provider’s application for enrollment. Newly enrolling homecare providers are in the ‘high’ risk screening category. Homecare providers seeking to reactivate their Medicare billing privileges will be subject to the ‘moderate’ level of screening. For homecare providers revalidating their enrollment, a site visit is required prior to revalidation. Transmittal 371, Change Request 7350 (CR7350), dated March 23, 2011, details the new screening criteria, application fees, and instructions issued to the MACs.

The ‘high’ risk screening category consists of a site visit that must meet the criteria in CR7350. The enrollment fee for the period of March 25, 2011 through December 31, 2011 is $505.00 and fee amounts for future years will be adjusted by the percentage change in the consumer price index for the 12-month period ending on June 30 of the prior year.

Homecare providers, upon receipt of the revalidation request, have 60 days from the date of the request to submit complete enrollment forms-including the fee. Providers can revalidate via the Internet-based PECOS on the CMS website.