Incorporation of Recent Provider Enrollment Regulatory Changes into Chapter 10 of CMS Publication 100-08

Posted in INDUSTRY NEWS, Long-Term Care

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

CMS posted Transmittal 11701 – Change Request 12865 on November 10, 2022 with same title as this blog. 

The updated Chapter 10 (Medicare Enrollment) begins on page 6 of the 44-page transmittal. As per usual, look for the red ink within Chapter 10 for the changed/added verbiage.

10.2.1.14 – Skilled Nursing Facilities (SNFs) begins on page 12.

  • Effective January 1, 2023, SNFs that are initially enrolling or undergoing a change in ownership (as described in sections 10.6.15 and 10.6.21(E)(3) of this chapter) fall within the “high” screening category under 42 CFR § 424.518. SNF revalidations are processed at the “moderate” screening level.
  • No later than 5 business days after receipt of the recommendation from the state, the contractor shall order the site visit described in subsection (D)(1) below. If the SNF fails the site visit, the contractor shall follow the denial procedures addressed in subsection (B)(2)(b) above. If the SNF passes the site visit, the contractor shall (within 3 business days of completing its review of the results) send an e-mail to MedicareProviderEnrollment@cms.hhs.gov with the following information and documents:
  • D. Site Visits 1. Initial application – The scope of the site visit shall be consistent with sections 10.6.20(A) and 10.6.20(B) of this chapter. The NSVC will perform the site visit. The contractor shall not convey Medicare billing privileges to the provider prior to the completion of the NSVC’s site visit and the contractor’s review of the results.

2. Revalidation – If a SNF submits a revalidation application, the contractor shall order a site visit through PECOS. This is to ensure that the provider is still in compliance with CMS’s enrollment requirements. The scope of the site visit shall be consistent with sections 10.6.20(A) and 10.6.20(B) of this chapter. The NSVC will perform the site visit. The contractor shall not make a final decision regarding the revalidation application prior to the completion of the NSVC’s site visit and the contractor’s review of the results.

(See sections 10.6.15 and 10.6.21(E)(3) for instructions regarding site visits for ownership changes.)

Keep reading as there are a number of changes – see II. earlier in this blog for the overview of changes.