Vendor Compliance

In case you haven’t seen it yet, The Centers for Medicare & Medicaid Services (CMS) issued a letter to state Medicaid director clarifying the requirements for vendor checks prior to receiving payments. While you may not be a state Medicaid director, if you’re planning to process payments through your state’s Medicaid office, you’ll want to know what they are looking for.

Highlights from the letter:

Frequency of Checks

States are guided to review eligibility at enrollment or re-enrollment as well as monthly. The monthly checks are to identify reinstatements as well as new exclusions.

Who to Check

States are reminded that they must look at out-of-State as well as in-State providers.

Comprehensive Disclosure of Ownership

Because payments to a provider that has an excluded individual as owner (5% or greater) or a managing executive are prohibited, States should be wary of incomplete disclosure information and should not process payments from that company without further research.

You can read the letter yourself here.