Part B Insider (Multispecialty) Coding Alert

Published on Sat Sep 19, 2009 PDF

Make sure your carrier's system has accurate information for your practice.

Effective Nov. 2, your practice might be getting a house call from Medicare, and the purpose is simply to make sure you're there.

According to CMS Transmittal 306, "all providers and suppliers are subject to unannounced site visits prior to receiving Medicare billing privileges or subsequent to receiving Medicare billing privileges."

In certain cases, CMS will instruct a MAC to make a visit to a medical practice to determine if the practice is operational at the address on file. If the MAC representative can't tell from an external check-up whether the practice is in operation, the MAC rep "shall conduct an unobtrusive site verification by limiting its encounter with provider or supplier personnel or medical patients."

If your office is closed when the MAC rep arrives, but it doesn't appear that the office is non-operational, the MAC will come back to re-check.

If the MAC determines that the practices is not operational at the address on file, the MAC will revoke the practice's billing privileges within seven days, unless the provider has submitted a change of address to Medicare.

The transmittal most likely aims to discourage "sham" operations from setting up shop -- those storefront buildings that set up Medicare billing privileges and submit fraudulent claims but don't actually see patients. However, the new regs could bleed over to affect legitimate providers who simply forgot to update an address change.

Tip: If you've moved recently, make sure your MAC has the right contact information on file for your practice.

"The best and most effective way for providers to verify their information would be to contact customer service at the appropriate MAC," advises Sandie Becker, CMC coding and reimbursement specialist with the Santa Clara County Medical Association and Monterey County Medical Society in California.

To read Transmittal 306, visit http://www.cms.hhs.gov/transmittals/downloads/R306PI.pdf.