Medicare Site Visit Checklist for Physical Therapists in Private Practice:
- Signage
- Hours of Operation
- Confirmation that you are open for business.
- Confirm that you are treating patients at the clinic.
I have completed over 200 Medicare provider enrollments and over that experience, I have learned many lessons. In this article, I plan to share information about the Medicare Site Visit for physical therapists in private practice.
When is a Medicare Site Visit performed?
Medicare has indicated 4 scenarios in which a site visit may be performed:
- Initial application – if a physical therapist or physical therapist group submits an initial application, the contractor shall conduct a site visit prior to the contractor’s final decision regarding the application.
- Revalidation – If a physical therapist or physical therapist group submits a revalidation application, the contractor shall conduct a site visit prior to making a final decision regarding the application.
- New location – If a physical therapist or physical therapist group submits an application to add a new practice location, the contractor shall conduct a site visit of the new location prior to making a final decision.
- Reactivation – If a physical therapist or physical therapist group submits a reactivation application, the contractor shall conduct a site visit prior to making a final decision.
If I am a Mobile Physical Therapist will Medicare require a Medicare Site Visit?
No, Medicare does not require a site visit for mobile-only physical therapists who only treat Medicare beneficiaries in the patient’s home.
“If a physical therapist’s practice location is his or her home address and he or she exclusively performs services in patients’ homes, nursing homes, etc., the contractor shall not be required to perform a site visit.” Link
Initial Medicare Provider Application
A physical therapist in private practice enrolling as a Medicare provider for the first time with a brick-and-mortar clinic is required to have a site visit.
The site visit will be unannounced.
Contractors performing the site visit will document the date and time of the visit. They will take photos of the facility and document observations such as if the facility is open for business and operational or closed or vacant.
Revalidating a Medicare Provider Enrollment
Revalidating your Medicare provider enrollment is also called renewing. It is most often performed every 5 years.
When a physical therapist in private practice is revalidating a Medicare provider enrollment using the PECOS system or paper revalidation the Medicare contractor will perform a site visit to ensure the business is still in compliance and operational.
Adding a New Location to a Medicare Provider Enrollment
It is easy to add a new practice location to an existing physical therapy provider enrollment using PECOS.
Don’t add the new location in PECOS until it is open for business. Once you are open and treating patients you have 30-days to add the new location to your existing physical therapy practice enrollment.
Reactivation / Reactivating an Expired Enrollment
In some cases, a physical therapist in private practice might allow their enrollment to expire. If this happens, the organization will be required to submit a reactivation application using a paper enrollment or PECOS.
Before approval is issued a site visit will be performed by the contractor.
How to Apply to Become a Medicare Provider
If you would like help learning how to complete your Medicare provider enrollment using the PECOS system please visit this page: How To Credential A Physical Therapist With Medicare Part B
