CMS is increasingly scrutinizing provider-based regulatory compliance. CMS actively seeks to remove excepted (“grandfathered”) status from off-campus sites that fail to adhere to regulatory expectations. CMS regularly audits enrollment records that may result in payment holds or denials. Provider-Based sites must be en garde.
Recent CMS provider-based reviews typically stem from various triggering events. Most often, CMS review result from:
- Patient complaints;
- Billing/coding audits;
- Medicare 855A enrollment record reviews;
- Revalidation surveys; and
- The Joint Commission findings.
In short, provider-based compliance is now more important than ever.
As a tool to assist hospitals in provider-based monitoring, Advis has prepared its “Provider-based FAQs: 10 Key Questions for Organizations to Ask.” The information in these FAQs stems from the regulatory requirements and Advis’ extensive experience with successfully demonstrating compliance to CMS.