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.