Fingerprinting Required for High Risk Providers, Suppliers

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  • October 9, 2014
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You might not remember, but back in 2011, the Centers for Medicare & Medicaid Services (CMS) published a rule that added a new security provision to the provider enrollment process. That provision has come to fruition: CMS implemented a fingerprint-based background requirement on August 6.
Fingerprint-based background checks are now required for all individuals with a 5 percent or greater ownership interest in a provider or supplier that falls into the high-risk category and is currently enrolled in Medicare or has submitted an initial enrollment application.
Expect a Letter
Medicare administrative contractors (MACs) have begun sending letters to such providers/suppliers, listing all owners who require fingerprinting. If you receive such a letter, you have 30 days from the date of the letter to comply. Noncompliance could result in denial of your Medicare enrollment application or revocation of your Medicare billing privileges.
CMS awarded a contract for fingerprinting-based background checking to Accurate Biometrics, Chicago, Illinois, on July 8.
Who Is High Risk?
Per 42 CFR 414.518, “Screening levels for Medicare providers and suppliers,” CMS has designated the following home health agencies and suppliers of durable medical equipment, prosthetics, and supplies (DMEPOS) as “high” categorical risk for Medicare fraud, waste and abuse:

  1. Prospective (newly enrolling) home health agencies
  2. Prospective DMEPOS suppliers

For more information, see MLN matters® Special Edition Article No. SE1427.

Renee Dustman
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Renee Dustman, BS, AAPC MACRA Proficient, is managing editor - content & editorial at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 30 years' experience in journalistic reporting, print production, graphic design, and content management. Follow her on Twitter @dustman_aapc.

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