decisionhealth Newsletters, Answer Books - 2009 Issue 10 (October)
Answer_Book / Enrollment_in_Medicare / CMS ramps up enforcement with address checks
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Article Overview
This article covers Medicare enrollment enforcement actions related to practice address verification. It discusses carrier and MAC mailings, site inspections, handling of undeliverable mail, and the administrative consequences of outdated enrollment records. The content is aimed at physicians, non-physician practitioners, and billing/enrollment staff who manage Medicare participation records.
Why This Topic Matters
Accurate enrollment and practice location information can affect whether Medicare contractors maintain billing privileges and how providers respond to address-related verification activity. The article helps readers understand the operational and compliance importance of keeping enrollment records current.
Article Sections
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CMS ramps up enforcement with address checks
Overview of Medicare enrollment enforcement activity centered on practice address verification and contractor outreach. The section frames the broader compliance focus for enrolled providers and practitioners.
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Carriers may pay you a call
Discussion of site inspections and contractor verification of practice locations during normal business hours. The section covers address-file review and the administrative process that may follow unsuccessful verification.
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Solo practices get special attention
Coverage of targeted mailings and enrollment-file checks for selected solo physicians and non-physician practitioners. The section addresses contractor handling of undeliverable correspondence and related enrollment follow-up.
What You Will Learn
- How Medicare contractors verify practice addresses during enrollment oversight
- What types of enrollment mailings and site checks are discussed in the article
- Why keeping enrollment records current is important for providers and practitioners
- Which provider groups receive special attention in the described enforcement activity
Who Should Read This
- Physicians
- Non-physician practitioners
- Medical billing staff
- Enrollment staff
- Practice managers
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