By: Michelle Duncan
Effective 02/02/09, the National Supplier Clearinghouse Medicare Administration Contractor (NSC-MAC) will begin performing fraud analyses of all current DMEPOS suppliers, initial applicants and Medicare re-enrollment applicants.
DMEPOS suppliers will be assigned one of four fraud and abuse risk levels, ranging from low risk to high risk. The NSC-MAC will take the following seven factors into consideration, along with information from the OIG, CMS and/or a PSC when accessing a supplier’s risk level:
- Experience as a DMEPOS supplier with other payers
- Prior Medicare experience
- Geographic location
- Fraud potential of products and services provided
- Site visit results
- Accreditation of the supplier
Review plans will be established for DMEPOS suppliers based on their risk levels and may include a set number of unscheduled site visits and/or maximum billing quotas a supplier must meet.
A supplier’s risk level will be updated on a yearly bases. Please click here for complete details from CMS (Chapter 10 of the Medicare Program Integrity Maunal).