Portable X-Ray Suppliers (PXRSs)

10.2.2.8 – Portable X-Ray Suppliers (PXRSs) (Rev. 12717; Issued: 07-18- 24; Effective: 08-19-24; Implementation: 08-19-24) PXRSs are a certified supplier type that enroll via the Form CMS-855B. A. Background To qualify as a PXRS, an entity must meet the conditions for coverage discussed in 42 CFR § 486.100-110. A PXRS can be simultaneously enrolled as a mobile independent diagnostic testing facility (IDTF), though they cannot bill for the same service. A PXRS requires a state survey, while a mobile IDTF does not (although an IDTF requires a site visit). A PXRS does not have a supplier agreement. B. Processing Instructions for PXRS Initial Form CMS-855B Applications 1. Receipt of Application Upon receipt of a PXRS initial Form CMS-855B application, the contractor shall undertake the following (in whichever order the contractor prefers unless directed otherwise in this chapter): (A) Perform all data validations otherwise required per this chapter. (B) Ensure that the application(s) is complete consistent with the instructions in this chapter. (C) Ensure that the PXRS has submitted all documentation otherwise required per this chapter. For PXRS initial enrollment, this includes the Form CMS-1880 (Request for Certification as Supplier of Portable X-Ray Suppliers) If the Form CMS-1880 is missing, unsigned, undated, or otherwise incomplete, the contractor need not develop for the form(s) or the information thereon; the contractor shall instead notify the state in its recommendation letter which document(s) was/were missing or otherwise incomplete. For all other missing or incomplete required documentation, the contractor shall follow the normal development instructions in this chapter. 2. Conclusion of Initial Contractor Review (Nothing in this section 10.2.2.8(B) prohibits the contractor from returning or rejecting the PXRS application if otherwise permitted to do so per this chapter. When returning or rejecting the application, the contractor shall follow this chapter’s procedures for doing so.) (A) Approval Recommendation If, consistent with the instructions in section 10.2.2.8(B) and this chapter, the contractor believes an approval recommendation is warranted, the contractor shall send the recommendation to the state pursuant to existing practice and this chapter’s instructions. The contractor need not copy the SOG Location or PEOG on the recommendation. Unless CMS directs otherwise, the contractor shall also send to the provider the notification letter in section 10.7.5.1(E) of this chapter. The state will: (1) review the recommendation package for completeness; (2) review the contractor’s recommendation for approval; (3) perform any state-specific functions; and (4) contact the contractor with any questions. The contractor shall respond to any state inquiry in Item (4) within 5 business days. If the inquiry involves the need for the contractor to obtain additional data, documentation, or clarification from the PXRS, however, the timeframe is 15 business days; if the provider fails to respond to the contractor within this timeframe, it shall notify the state thereof. The contractor may always contact its PEOG BFL should it need the latter’s assistance with a particular state inquiry. (B) Denial If the contractor determines that a denial is warranted, it shall follow the denial procedures outlined in this chapter. This includes: (1) using the appropriate denial letter format in section 10.7.8 of this chapter; and (2) if required under section 10.6.6 (or another CMS directive) of this chapter, referring the matter to PEOG for review prior to denying the application. 3. Completion of State Review The state will notify the contractor once it has completed its review. There are two potential outcomes: (A) Approval Not Recommended If the state does not recommend approval, it will notify the contractor thereof. (The contractor may accept any notification that is in writing (e-mail is fine).) A site visit need not be performed. No later than 5 business days after receiving this notification, the contractor shall commence the actions described in section 10.2.2.8(B)(2)(B) above. (B) Approval Recommended If the state recommends approval, it will typically (though not always) do so via a Form CMS- 1539; the contractor may accept any documentation from the state signifying that the latter recommends approval. (Note that the contractor will not receive a formal tie-in notice.) No later than 5 business days after receipt of the recommendation from the state, the contractor shall order a site visit as described in this chapter. If the PXRS fails the site visit, the contractor shall follow the denial procedures addressed in subsection (B)(2)(B) above. If the PXRS passes the site visit, the contractor shall (within 3 business days of completing its review of the results) send an e-mail to MedicareProviderEnrollment@cms.hhs.gov with the following information and documents: • The Form CMS-855 application (or PECOS Application Data Report) and all application attachments. • A copy of the Form CMS-1539 or similar documentation received from the state • A copy of the supplier-signed Form CMS-1880 • A copy of the draft approval letter, with the effective date shown on the Form CMS-1539 (or similar documentation) included in the draft letter. (See section 10.7.5.1 for the model approval letter.) Based on the information received from the contractor, PEOG will (1) assign an effective date, (2) assign a CCN, and (3) enter the applicable data into ASPEN, and (4) approve (with possible edits) the approval letter. Within 5 business days of receiving from PEOG the effective date, and CCN, the contractor shall: (1) send the approval letter to the PXRS; (2) send a copy of the approval letter to the state and/or AO (as applicable); and (3) switch the PECOS record from “approval recommended” to “approved” consistent with existing instructions. C. Site Visits 1. Initial application –The scope of the site visit will be consistent with sections 10.6.20(A) and 10.6.20(B) of this chapter. The NSVC will perform the site visit. The contractor shall not convey Medicare billing privileges to the provider prior to the completion of the NSVC’s site visit and the contractor’s review of the results. 2. New/changed location - If a PXRS is (1) adding a new location or (2) changing the physical location of an existing location, the contractor shall order a site visit of the new/changed location through PECOS no later than 5 business days after the contractor receives the approval recommendation from the state but before the contractor sends to PEOG the applicable e-mail described in section 10.6.1.2(A)(3) of this chapter. (See the latter section for more information. This is to ensure that the new/changed location complies with CMS’s enrollment requirements. The scope of the site visit will be consistent with sections 10.6.20(A) and 10.6.20(B) of this chapter. The NSVC will perform the site visit. The contractor shall not make a final decision regarding the change of information application prior to the completion of the NSVC’s site visit and the contractor’s review of the results. D. Reassignment PXRSs may receive reassigned benefits. A PXRS need not separately enroll as a group practice in order to receive them. E. Practice Location Information In Section 4 of the Form CMS-855B, the PXRS must furnish certain information, including: • Whether it furnishes services from a “mobile facility” or “portable unit.” (A PXRS can be either, though it usually is a portable unit.) A “mobile facility” typically describes a vehicle that travels from place to place to perform services inside the vehicle. Examples of such vehicles include mobile homes and trailers. A portable unit involves a supplier transporting medical equipment to a particular location. Unlike with mobile facilities, the equipment on a portable unit is separate from and unattached to the vehicle. • Its base of operations. This is from where personnel are dispatched and where equipment is stored. It may or may not be the same address as the practice location. • All geographic locations at which services will be rendered. • Vehicle information if the services will be performed inside or from the vehicle. Unless stated otherwise in this chapter or in another CMS directive, copies of all licenses and registrations must be submitted as well. F. Additional Enrollment Information The contractor shall include any licenses, certifications, and accreditations submitted by PXRSs in the enrollment package that is forwarded to the state. If the PXRS’s address or telephone number cannot be verified, the contractor shall contact the applicant for further information. If the supplier states that the facility or its phone number is not yet operational, the contractor shall continue processing the application. However, it shall indicate in its recommendation letter to the state that the address and telephone number of the facility could not be verified. When enrolling the PXRS, and except as otherwise stated in this chapter or as otherwise instructed by PEOG, the contractor shall use the effective date that is indicated on the state approval letter/notice. This is the date from which the supplier can bill for services. G. PXRS Changes of Ownership (CHOWs) and Changes of Information Though PXRSs are not mentioned in 42 CFR § 489.18, CMS generally applies the CHOW provisions of § 489.18 to them. CHOWs involving PXRSs are thus handled in accordance with the principles in § 489.18 and Pub. 100-07, chapter 3, sections 3210 through 3210.5(C). For PXRS CHOW processing instructions, see section 10.6.1.1 of this chapter. The contractor shall process PXRS changes of information in accordance with section 10.6.1.2 of this chapter. H. Additional Information For more information on PXRSs, refer to: • 42 CFR §§ 486.100 – 486.110 • Pub. 100-07, chapter 2, sections 2420 – 2424B • Pub. 100-02, chapter 15, sections 80.4 - 80.4.4 • Pub. 100-04, chapter 13, sections 90 - 90.5