On Site Supplier Reviews

This news item was published today by Cigna, one of the DME MACs. It applies to optical dispensaries, since they are considered “suppliers” under the Medicare program. Practices should make their employees aware of the possibility of visits like this.

March 18, 2010
On-Site Supplier Reviews

CMS instructs contractors to analyze provider compliance with Medicare coverage and coding rules and take appropriate corrective action when providers are found to be non-compliant. In order to meet this goal, Medicare contractors may determine that it is appropriate to conduct an on-site claim review at the supplier’s place of business.

Medicare contractors may, but are not required, to provide advance notice of a supplier site review. However, any Medicare contractor staff person who visits a supplier’s site must show photo identification so the supplier has verification of their affiliation with the Medicare contractor.

During a supplier site visit, the reviewers will hold entrance and exit interviews with the appropriate supplier staff. A supplier representative can also be present while the claims are being reviewed and the reviewers will answer any questions the supplier’s staff may have.

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