Fingerprinting: New opportunity for 'mistakes and delays'

WASHINGTON - HME providers who want to do business with Medicare will have to navigate through another layer of bureaucracy starting some time this year.

CMS will begin phasing in fingerprint-based background checks for HME and home health providers in 2014, the agency announced in a MLN Matters article published this week.

“Apart from the inconvenience of being fingerprinted, think of all the new opportunities for mistakes and delays from CMS and this new contractor,” said healthcare attorney Elizabeth Hogue. “How unfair is it that we are characterized this way.”

CMS will first require fingerprinting for newly enrolling and other high-risk providers. Eventually, however, it will require fingerprinting for all individuals with a 5% or greater ownership in an HME or home health company.

While it will take time for CMS to ramp up the program, providers may receive a notification letter from their Medicare Administrative Contractor (MAC) to get fingerprinted sooner than they think. Attorneys point out that providers may be thrown into the fire when they re-enroll with the National Supplier Clearinghouse (NSC), something they have to do every three years.

“In theory, a provider could have to do this in no more than three years,” said Neil Caesar, president of the Health Law Center.

New details on the program include: Providers will have 30 days from the date of the notification letter to be fingerprinted; once they receive a letter, providers must contact the Fingerprint-Based Background Check Contractor (FBBC) to get the names of three places where they can get fingerprinted; and providers will incur the cost of having the fingerprints taken.

The process may be a logistical challenge for some providers if a similar requirement already implemented by Florida's Medicaid program is any indication, attorneys say.

“From my experience in Florida, when helping a rural provider or an out-of-state provider who doesn't have as easy access to these outfits, it is nearly impossible to do this compliantly,” said Todd Moody, a healthcare attorney with Brown & Fortunato. “I've submitted five different cards for the same person and haven't been able to get it through. I see this as being a challenge.”

Other details: Once the process is complete, the fingerprints will be forwarded to the FBI for processing; within 24 hours, the FBI will compile a background history and will share the results with the FBBC; the FBBC will assess the law enforcement data provided and provide a “fitness recommendation” to CMS; CMS will assess the recommendation and make a final determination.

CMS says it will rely on its existing authority to deny enrollment applications and revoke Medicare billing privileges if an individual has submitted an enrollment application that contains false or misleading information.

“I rarely say this, because it sounds self-serving, but when it comes to re-enrollment, providers need to seek legal counsel to review their application and make sure it's completed correctly,” Hogue said. “It's gotten so complex now.”