CMS Readies Fingerprint Background Checks for Home Health Providers

The Centers for Medicare & Medicaid Services (CMS) will finally begin implementing its long-heralded fingerprint-based background checks for home health providers.

As part of enhanced enrollment screening provisions contained in the Affordable Care Act, CMS announced it is beginning to phase in the implementation of fingerprinting background checks—an initiative three years in the making.

The federal overseeing of the Medicare and Medicaid programs hopes to use fingerprinting to detect “bad actors” attempting to enroll in the Medicare program as well as to remove those currently enrolled.

That being said, once fully implemented, the fingerprint-based checks will be completed on all individuals with a 5% or greater ownership interest in a provider or supplier that falls under the “high risk” category, CMS stated in an alert.

The high level of risk categories will be applied to home health agencies, as well as providers and suppliers who are newly enrolled in Durable Medicare Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS).

CMS has the authority to adjust a particular provider’s or supplier’s screening level from “limited” or “moderate” to “high” in the event of a number of circumstances, according to the National Association for Home Care & Hospice (NAHC).

One instance where a company might have their screening level adjusted can be if CMS has imposed a payment suspension on that provider or supplier at any time within the last 10 years, NAHC reports.

If a provider or supplier has been excluded from Medicare by the Office of the Inspector General; has had its billing privileges revoked by a Medicare contractor within the last 10 years or has been terminated from billing Medicaid or excluded from any federal health care program might also warrant for a screening change.

CMS will notify applicable providers and suppliers of the fingerprint requirements via Medicare Administrative Contractors, which will send a notification letter to those providers or suppliers listing all 5% or greater owners who are required to be fingerprinted.

Individuals will then have 30 days from the date of the notification letter to be fingerprinted, CMS stated.

Read more here

Written by Jason Oliva