Process Revisions for Changes of Information for Medicare Certified Providers (From NAHC)

The Centers for Medicare & Medicaid Services (CMS) recently released revised instructions (Transmittal 10975/Change Request (CR) 12386) for processing of Medicare-certified provider information,  transitioning certain functions from the  Survey & Operations Group (SOG) Locations (formerly known as Regional Offices) to the Medicare Administrative Contractors (MACs) and the Provider Enrollment & Oversight Group (PEOG), which is part of the Center for Program Integrity.

In particular:

• the SOG Locations will be much less involved in the process;
• tie-in and tie-out notices will no longer be issued;
• the contractor will be responsible for finalizing changes previously requiring SOG Location approval; and
• recommendations of approval will be made to (and reviewed by) the state agency (hereafter occasionally referenced simply as “state”) only and not the SOG Location.

The Medicare Administrative Contractors (MACs) process these changes after becoming aware of them through the provider-submitted CMS Form 855 for actions such as revalidation, change of location, addition of an HHA branch or hospice multiple locations, etc.  State offices (i.e. state survey entities) remain involved in the various changes of information and may still be conducting surveys for some changes, as applicable.

This Transmittal updates Chapter 10 of the Medicare Program Integrity Manual.

Providers are encouraged to review the Transmittal considering any changes they may have to report on upcoming revalidations or otherwise.