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Mistakes To Avoid During Onsite CMS Medicare Verification Visits


Medicare providers and suppliers must be prepared for a site visit as part of the provider enrollment or verification process

This important visit helps the Centers of Medicare & Medicaid Services (CMS) determine that your business is legitimate and the information submitted to their systems for Medicare enrollment is correct.  

You can read more about this requirement in our earlier blog.

Although an on-site visit by CMS is nothing to worry about for legitimate health care businesses that are fully compliant with Medicare requirements, you should still be on your toes to ensure that nothing goes wrong. 

Here is our list of common mistakes to avoid that may jeopardize your ability to provide services to Medicare beneficiaries:

  • Not checking that the information for each practice location is correct and on file. Complete and accurate location information must be recorded with your Medicare enrollment contractor so the CMS auditor can find your business. 
  • Omitting to report changes to existing practice locations. This includes any address change, telephone number and hours of operation.
  • Having inadequate or missing signage identifying your practice. Your business name should be clearly shown at your location so that an auditor can find you. Remember to include posted hours of operation as well. CMS site visits should occur during your posted hours or on Monday through Friday, 9:00 am to 5:00 pm. So if your hours are different than these andare not posted, or if your business is closed at the time of the visit, the auditor may not be able to find you and so will record that your business is not operational. As an example, a fully compliant physician who operates within a nursing facility may not be able to be located during an audit since the exterior signage indicates only facility information.
  • Not cooperating with the CMS auditorMedicare providers and suppliers are expected to accommodate verification or reverification requests while the auditor is onsite. The auditor will take photos, and staff should be ready to be interviewed if requested as well as fully answer all questions.

Failure to meet any verification requirements including an onsite visit may result in denial of your enrollment application along with revocation of Medicare billing privileges.

Let Us Manage All Your Payer Enrollment Services

If you require medical credentialing and payer enrollment needs for your practice or medical facility, please contact 1st Assistant. Our experienced and dedicated specialists will provide all credentialing and enrollment services quickly and will monitor your account for ongoing updates and re-attestations. Heidi Henderson, our company owner and President, is eager to meet you and discuss your payer enrollment needs. Please call us at 512.201.2668 or contact us via the website.

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