NPE Site Visits
What You Need to Know
CMS requires unannounced site visits to ensure compliance with Medicare regulations and DMEPOS Supplier Standards. These visits may take place during initial supplier enrollment, revalidation, reactivation, or any other time, as deemed necessary by the National Provider Enrollment Contractors. During the visit, the inspector will likely take photos and ask for specific documents, such as:
- Licensure
- Certificate of General Liability Insurance
- Inventory or contract with a manufacturer
- Complaint resolution protocol and complaint log
- Warranty coverage notification
- Rent/Purchase option notification
- List of owners/managers
- Surety Bond Agreement
- Accreditation information
- Written instruction/information on beneficiary use/maintenance of supplies
- Business sign with company name and hours of operation
- Physical location must meet all federal accessibility guidelines
If a site visit is refused or unable to be conducted, the supplier is subject to denial/revocation of Medicare billing privileges.
What This Means for You
Most site inspections are in response to an application you submit (i.e., initial Medicare enrollment, revalidation, or reactivation), and you typically receive notice from your NPE contractor that a site visit is coming. However, the actual visit date and time is not scheduled, and the NPE contractors also have the right to conduct a site visit at any time without notice. Therefore, it is important to make sure that you are always prepared. The following tips will help you stay prepared and increase your chances of a successful site visit.
- Become familiar with the DMEPOS Supplier Standards: Each item listed above specifically relates to one of the 30 supplier standards. You must remain compliant with (and provide proof of) each requirement to obtain and maintain your enrollment with Medicare.
- Review the On-Site Inspection Form: The site inspector is required to complete this form during their site visit. Reading through the document will help you better understand the requirements for a successful outcome.
- Understand exemptions: Some standards do not apply to all suppliers. For example, not all states require licensure, and those that do may have exemptions for specific types of providers (i.e., physicians within their scope of practice). Be sure to review the licensure database to determine whether licensure is required in your state for the specific products you provide. Furthermore, some providers are exempt from accreditation and surety bond requirements, as outlined here.
- Prepare your staff: Make sure that your office staff are aware of their roles and responsibilities during a site visit. Designate one person in the office to work directly with the site inspector, and they should have direct access to all the required documents (to help everything go quickly and smoothly, you can have copies of the required documents printed and placed in a designated binder or saved in a designated folder on their computer). It is also important that your front desk personnel are aware of potential site visits and contact the designated employee as soon as the site inspector arrives.
- Post correct business hours: Site visits will occur during the business hours listed on your application and/or posted at your office. If your office is closed during lunch, make sure this is clearly stated on your application and posted outside of your office. If a site inspector is not able to complete a site inspection during posted business hours, you are subject to denial or revocation of enrollment. Note: site visits are scheduled for mobile units or providers who are open by appointment only.
- Contact your NPE contractor with any concerns: The NPE contractors hire subcontractors to conduct the site visits, and they are required to show photo identification and a signed letter on CMS letterhead authorizing the visit. The inspector may also ask to review beneficiary files to determine compliance with certain supplier standards, but they should never take, copy, or photograph these files. If there are any concerns with regards to the validity of the inspector, or if they ask to take or copy beneficiary files, contact your NPE contractor immediately.
For more information on site visits, go to your NPE contractor’s website:
- Palmetto GBA (NPWest) - States west of the Mississippi River
- Novitas Solutions (NPEast) - States east of the Mississippi River