In the calendar year 2023 Medicare skilled nursing facility (SNF) payment rule, CMS elevated the SNF provider enrollment risk level from “limited” to “high”.  As a high risk level provider, one of the added requirements is a site visit by a CMS contractor who will visit facilities for a short period to take some photos to verify that the location exists and is operating as a SNF.

These site visits have begun.  We wanted to provide this additional alert.  Important, the visiting contractor is not a federal or state surveyor.  They will present at your facility for the above specific purpose. The site visits will occur only Monday – Friday (no weekends) but are unannounced.  For Wisconsin facilities, the national site visit contractor will be Palmetto GBA or one of its subcontractors:  Overland Solutions, Inc., an affiliate of EXL, Information Discovery Services or Compliance Review, Inc.  The inspector is expected to present appropriate identifying credentials.  Additional guidance from the Wisconsin Division of Quality Assurance is set forth below:

What to Know About CMS’ Unannounced Nursing Home Visits

The Division of Quality Assurance is sending this message as part of our commitment to Collaboration, Innovation, and Quality.

The Centers for Medicare and Medicaid (CMS) sub-contractor inspectors are conducting unannounced visits to nursing homes.

Visit Purpose
In January 2023, CMS changed the designation of skilled nursing facilities from a “limited risk” provider for all enrollment actions to “high risk.” This changed the requirement for site visits. As part of the site visit, CMS sub-contractors are required to make site visits and take photos of the nursing home and skilled rehabilitation.

Identification
The inspector may identify themselves as being a CMS sub-contractor or working for a Medicare Administrative Contractor (MAC).

The inspector must provide a photo ID (they do not have a government employee or contractor identification) and a CMS letter of authorization. This letter has a QR code that links to the MAC contact list for providers to call if they would like to verify the visit. Providers may review but not obtain or copy the identification or letter. If concerned, providers should contact their MAC directly to verify the legitimacy of the site visit. Providers should have their National Provider Identifier (NPI) available when contacting the MAC.

More Information
For more information on the site visit requirements and tips, see this CMS presentation. Additional information on CMS’s authority to conduct visits on all providers through the site visit process may be found online from CMS outreach at Medicare Provider Enrollment MLN (Enrollment tab, step 3) and in the MLN newsletter Provider & Supplier Enrollment Site Visits: CMS has Authority to Conduct.

Questions
If you have questions regarding this information, contact Ann Angell, Director of BNHRC, at Ann.Angell@dhs.wisconsin.gov, or Jessica Radtke, Deputy Director of BNHRC at Jessica.Radtke@dhs.wisconsin.gov, or your Regional Field Operations Director.