Frequently Asked Questions


With respect to the site visit, how can we determine which screening category we are in ? How do we know if we have to pay the application fee?

Beginning on March 25, 2011, Medicare will place newly-enrolling and existing providers and suppliers in one of three levels of categorical screening: limited, moderate, or high. The risk levels denote the level of the contractor's screening of the provider or supplier when it among other things, revalidates its enrollment information. Chapter 15, Section 19.2.1 of the "Program Integrity Manual" (PIM) provides the complete list of these three screening categories, and the provider types assigned to each category, and a description of the screening processes applicable to the three categories (effective on and after March 25, 2011), and procedures to be used for each category.

Providers and suppliers who are in moderate screening categories are subject to announced and unannounced on-site visits that will be conducted by the Medicare Administrative Contractors (MACs).For purposes of CMS -6028 FC, specifically for purposes of this regulations, CMS has defined "institutional provider" to mean any provider or supplier that submits a paper Medicare enrollment application using the CMS-855A, CMS-855B (except physician and non-physician practitioner organizations), or CMS-855S or associated Internet-based PECOS enrollment application. Only institutional providers and suppliers are required to pay the application fee. For providers and suppliers who are required to pay the application, the application fee is $505 for applications received on or before December 31, 2011; $523 for applications received January 1, 2012 through December 31, 2012; and $532 for applications received January 1, 2013 through December 31, 2013.

The following links you directly to the article which addresses the Affordable Care Act related to provider enrollment screening, provider screening levels, and the application fees. and


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