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Medicare Site Visits

A mailbox at the packing and shipping store is not a practice location.

Medicare requires providers and suppliers to provide accurate enrollment information on their applications.  Medicare also requires those providers and suppliers to certify that they meet and continue to meet the Medicare enrollment requirements.

Physicians, and non-physician practitioners are required to report most changes in their enrollment information to Medicare within 90-days, but a change in the practice location must be reported within 30-days. Medicare is taking action against providers and suppliers that fail to adhere to these requirements.

An anesthesiologist had his Medicare billing privileges revoked because an on-site visit by the Medicare administrative contractor revealed that the practice was not compliant with Medicare regulations.  The anesthesiologist listed a mailbox unit in the local UPS store as his practice location on his Medicare re-validation application.  When the Medicare administrative contractor attempted to perform an on-site visit, the contractor determined the anesthesiologist was not operational at the practice location.  The Medicare administrative contractor also imposed a two-year ban on the anesthesiologist re-enrolling in Medicare.

The anesthesiologist appealed the revocation decision all the way to the Department of Health and Human Services (HHS) Departmental Appeals Board (DAB).  Throughout the appeal process, the anesthesiologist argued that he did not maintain a private office where he provided treatment to patients.  Instead, he provided anesthesia services to patients at multiple facilities.  On April 8, 2016, the DAB affirmed the decision to revoke the anesthesiologists Medicare billing privileges, and the two-year bar on the physician re-enrolling in Medicare.  The anesthesiologist, if he so chooses, may appeal to DAB decision to federal court.

Unfortunately for the anesthesiologist, the Medicare enrollment application provides very precise instructions on what constitutes a practice location including what constitutes the practice location of a physician that provides services in a hospital or other facility.

Section 4A of the Medicare enrollment application provides explicit instructions on what Medicare means by practice location.  Practice location is the physical location(s) where the practitioner currently provides health care services.  Practitioners that provide services in a hospital or other healthcare facility must provide the name and address of the facility(s) where those practitioners provide those services.  A practice location must be a specific street address as recorded by the United States Postal Service.  The practice location cannot be a post office box.

Section 4B of the Medicare enrollment application allows practitioners to designate a separate address for remittance notices and special payments.  That address may be the same as the practice location address, or it could be a different address including a post office box.

Section 4C of the Medicare enrollment application requires practitioners to provide the address where the practitioner stores patient medical records.  The address may be, but is not required to be, the same as the practice location(s).  Practitioners may not use a post office box address as the address where patient medical records are stored.

Surprisingly, the plight of the above anesthesiologist is not unique.  The same application forms used by physicians to enroll in Medicare are used by several different types of providers and suppliers including ambulance services and mobile providers that might never provide services in the same physical location twice.  The Medicare enrollment application and instructions advise mobile and portable providers and suppliers to list the location of their base of operations, which is the location from which personnel are dispatched, or where mobile/portable equipment is stored.

The revocation of a practitioner's Medicare billing privileges is disastrous to any provider even if those billing privileges can be reinstated within a few months.  Conversely, any re-enrollment bar is devastating to a practitioner and could potentially end the healthcare career of the practitioner.  Any practitioner that gets notice of a Medicare suspension or revocation should contact an attorney experienced in health law immediately.

Michael L. Smith is board certified in health law by The Florida Bar and practices at The Health Law Firm in Altamonte Springs, Fla.  This article is for general information only and is not a substitute for formal legal advice.

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