Nursing Facility Medicare Provider Enrollment Verification Site Visits

Nursing facility providers may receive site visits from the National Site Visit Contractor (NSVC) on behalf of the Centers for Medicare and Medicaid Services (CMS). The NSVC may take pictures of the building to verify practice location and structure to determine compliance with Medicare enrollment and other requirements (42 CFR §424.518). You can contact your Medicare Administrative Contractor (MAC) to verify the site visit.

The Calendar Year 2023 Medicare Physician Fee Schedule Final Rule contains information about requirements for Medicare provider enrollment, including §424.518, which describes the requirements for Medicare contractors to screen all initial, revalidation, change of ownership applications, and applications to report a new owner. There are three levels for screening: “limited,” “moderate,” or “high.” Providers categorized in the “moderate” or “high” risk category must undergo a site visit.

Read CMS Pub 100-08 Medicare Program Integrity Transmittal R11808PI (PDF), and Section J, Medicare Provider and Supplier Enrollment, in the Federal Register.

Read Medicare Learning Network – Provider Enrollment: Regulatory Changes Jan 2023 (PDF) for more information.