NSC Site Visit: What Should Suppliers Expect?

Site visits, to many suppliers, seem to be one of the more daunting events that occur during the enrollment process. The site visit along with the application and supporting documentation are considered in making a determination to issue, deny or revoke a supplier’s billing privileges. The answers to the frequently asked questions below are intended to educate suppliers on the site visit process and to give suppliers an idea of what to expect during the site visit.

Site Visits:

• Are a tool used by the NSC to assist in making a determination as to whether or not a supplier is in compliance with the 21 supplier standards
• Are conducted in all fifty states and territories
• Are completed for initial applications, reenrollments and reactivations
• Can and will be conducted at anytime if deemed necessary

Below are some frequently asked questions and answers regarding site visits:

When will an inspector visit my facility? Site visits are unannounced and may take place during the enrollment, reenrollment, reactivation process or at any other time as deemed necessary. Supplier Standard 8 requires the location to be accessible during reasonable business hours. If an attempt is made outside of your posted hours of operation, a subsequent attempt will be made during the posted hours of operation.

How many attempts are made to complete a visit? Generally, two attempts are made to complete a visit. However, if on the first attempt the inspector finds the facility is still under construction or other obvious indications the facility is not a true operating location, or there is no visible sign or office hours posted, the site inspector will not make a second attempt and the NSC will be notified the visit could not be completed.

If an attempt is made outside of the posted hours of operation, the inspector will leave a notice and will make a second attempt during the posted hours of operation. However, if the business is still inaccessible during the second attempt, the site inspector will not make any further attempts.

The hours of operation indicate when a supplier is open and available. During these hours, a beneficiary, CMS or its agents should be able to visit the facility. If a supplier goes to lunch from 1:00 pm to 2:00 pm, then this needs to be posted along with the hours of operation. If your posted hours state you are open from 9:00 am to 5:00 pm, then the supplier should be available from 9:00 am to 5:00 pm.

An initial application will not be denied because of the NSC or its subcontractor’s inability to conduct a site visit. In these cases, the applicant will receive a letter stating a site visit was unable to be conducted and to submit a new application at such time when a site visit can be completed.

How can I be sure the individual present to conduct the site visit is authorized to do so? An authorized site inspector, whether a NSC employee or a contractor, will have with them a photo identification card and a signed letter on CMS letterhead authorizing the individual to conduct the visit. Please note, the inspector will have a camera to take various pictures of the facility, sign, inventory, etc. The inspector will also have a questionnaire to complete based on the twenty-one supplier standards.

The inspector will ask to review your files to determine if you are in compliance with certain requirements of the supplier standards. However, the site inspector should not take the file, make copies or take pictures of the information contained in the file.

Please notify the NSC immediately if the site inspector requests to take the original or make copies of the beneficiary files or fails to present the photo ID or signed authorization letter. You should not give any information to an individual that is not properly credentialed. Please call 1-866-238-9652 to report any concerns.

What documentation might the site inspector request? The site inspector may ask for copies of any licensure you are required to have in order to operate your business. Copies of your insurance policy, IRS documentation or inventory contracts may also be requested. Suppliers should keep copies of all pertinent information where the supplier can easily access the documentation when this information is requested by an inspector.

The inspector stated my business passed the site visit and everything looked great, but my application was denied. Why? Site inspectors do not make decisions regarding your application. The site inspector’s job is to gather information and complete the site visit form. The NSC then uses this information along with the application and other information to make a determination of whether or not a supplier is in compliance with the supplier standards.

What does the inspector look for with regards to inventory? The inspector is there to document what inventory a supplier has in stock. The inspector will take pictures of the inventory and will ask questions from the checklist regarding inventory. If a supplier stores inventory at an offsite location, the supplier should notify the inspector and have the inspector take pictures of this inventory.

If the supplier does not have any inventory, the inspector may ask for a contact indicating how the supplier will obtain inventory necessary to fill beneficiary orders. The inspector should not make a determination of whether the contract is valid or meets Medicare requirements. Again, the inspector is there to gather information only.

For more information regarding inventory contracts, please review the answer to the FAQ What is considered an acceptable contract with regard to purchasing inventory?

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