Enrollment in Medicare will soon include “limited” screening for most physicians and non-physician practitioners.

CMS has combined physical therapy providers and physical therapy with a screening process that puts into effect anti-fraud measures required in the Patient Protection and Affordable Care Act.

That act explains provider screening measures, and details what will lead CMS to suspend Medicare payments. Some of the provisions will take effect March 25.

The Categories

• Limited: Carriers must confirm that providers meet Medicare requirements. They must verify licenses, Social Security Number, National Provider Identifier, and Taxpayer Identification, among others. Most NPP will fall into this category.
• Moderate: Providers could be subject to scheduled or unannounced visits. Physical therapy providers and therapy groups, including community mental health centers, comprehensive outpatient rehabilitation facilities, hospice groups, independent diagnostic testing facilities, independent clinical labs and portable X-ray suppliers are included in this category.
• High: Providers will be subject to criminal background checks. This category includes newly enrolling home health agencies and suppliers of durable medical equipment, prosthetics, orthotics, and supplies.

Payment suspension
At this time, Medicare allows for suspension of payment up to 180 days unless CMS supports a suspension.

In addition, “credible allegations of fraud” could cause a suspension in payment.

Allegations must be credible, however, before such action would be considered.