As part of the enhanced enrollment screening provisions contained in the Affordable Care Act, the Centers for Medicare & Medicaid Services (CMS) will be implementing fingerprint-based background checks for suppliers it considers high risk. The final rule covering these enrollment requirements was published in February 2011, but was not being enforced. That final rule also outlined new enrollment requirements for Medicare suppliers that are based on which of three risk groups suppliers are classified-limited, moderate, and high.
CMS has designated the following durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) providers as being high risk:
- Prospective (newly enrolling) DMEPOS suppliers, or those who are already in the Medicare program and are enrolling a new location.
- Individuals who maintain a 5 percent or greater direct or indirect ownership interest in the provider or supplier.
The four Durable Medical Equipment Medicare Administrative Contractors (DME MACs) will be sending all applicable high-risk suppliers letters informing them how to proceed with the fingerprinting and background check requirements.