By: Michelle Duncan

Effective February 02, 2009, suppliers enrolling in Medicare who are notified by their DME-MAC (or NSC-MAC) of missing documentation in their enrollment applications will be given 30-days to submit the missing documentation.

The 30-day window begins on the date the initial request for information (pre-screening letter) is sent by the DME-MAC. Although not required to do so, a DME-MAC’s future attempts to contact the supplier regarding the same missing documentation does NOT constitute a new 30-day period.

DME contractors may reject the application of any supplier who does not furnish all requested documentation or supporting information within 30 calendar days.

Should a provider’s Medicare enrollment be revoked by CMS or their DME-MAC (including NSC-MAC), the revocation will be effective 30 calendar days AFTER the initial notice of determination is sent. However, revocations due to debarment and Federal exclusion are effective the date of debarment or exclusion. Also, if the revocation is a result of a lapse in licenseure or certification, the revocation can be retroactive to the date of expiration. 

More information may be found in MLN Matters Article MM6282.

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:

1. Experience as a DMEPOS supplier with other payers
2. Prior Medicare experience
3. Geographic location
4. Fraud potential of products and services provided
5. Site visit results
6. Inventory
7. 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).