What do I Need to Know About Site Visits?

Answer:
Site visits are a crucial component of the enrollment process and are used to determine a supplier’s compliance with the DMEPOS supplier standards and other Medicare regulations. Site visits are unannounced and may take place during the initial enrollment, revalidation, reactivation process or at any other time as deemed necessary. Supplier standard 30 requires the location to be accessible for at least 30 hours per week unless otherwise exempt by supplier type.

Site visits are conducted by two separate CMS contractors. One contractor conducts site visits in states east of the Mississippi River and the other, west of the river. Each contractor uses subcontractors to perform inspections. Regardless, an authorized site inspector will have photo identification and a signed letter on CMS letterhead authorizing the individual to conduct the visit. Suppliers may not request copies of the photo identification or CMS letter. In addition, the inspector will have a camera to take various pictures of the facility, sign, inventory, etc. The inspector will have a questionnaire to complete based on the supplier standards. If there are any concerns with regards to the validity of the inspector, please contact the NPWest. 

Generally, two attempts are made. If an attempt is made outside of the posted hours of operation, a subsequent attempt will be made during the posted hours. However, if on the first attempt, the inspector finds the facility is still under construction, finds other obvious indications the facility is not a true operating location, or finds there is no visible sign or office hours posted, the site inspector will not make a second attempt and the NPWest will be notified the site visit could not be completed. If a site visit is refused or unable to be conducted, the supplier is subject to the denial/revocation of Medicare billing privileges.

The hours of operation indicate when a supplier is open and available. During these hours, a beneficiary, CMS, or its agent should be able to visit the facility. If a supplier closes for lunch this needs to be stated as well. If your posted hours state you are open from 9 a.m. to 5 p.m., an employee should be available for the entire time.

Depending on the type of supplier, any of the following documents may be requested:

• Any licensure required to operate the business
• Insurance policy showing compliance with supplier standard 10
• Copies of any contracts the supplier may have for inventory, instruction or repair services
• Complaint log and resolution protocol
• Rent/Purchase option notification
• Proof of warranty coverage

The inspector may also ask to review beneficiary files to determine compliance with certain supplier standards. However, the site inspector should never take, copy, or photograph beneficiary files. Please notify the NPWest immediately if the site inspector requests to take or copy beneficiary files.

The inspector will take pictures of the inventory and ask questions about the inventory. If a supplier stores inventory at an off-site location, the supplier should tell the inspector and advise of the address. If the supplier does not have any inventory, the inspector may ask for a contract.

Please note, the inspector is there to gather information only and not to determine compliance. The site visit results along with all enrollment documentation will be reviewed by the NPWest to determine supplier compliance.

Please see the article Site Visit Information for additional information.