Provider audit and reimbursement: Provider-based designation checklist
The provider-based designation checklist is a standardized tool developed by CMS. It is used by MACs to address key areas required to be met by an entity seeking approval for a provider-based status in accordance with 42 CFR 413.65. The checklist gives MACs the ability to identify and/or develop a list of the type of documentation necessary to address the various sections in order to make a determination within the expect CMS requirements.
In the process of requesting a provider-based status, providers are expected to file an attestation that addresses the various requirements to receive a determination. Generally, the attestation is accompanied by supporting documents and is subsequently reviewed by a MAC. It is critical to the review that proper supporting documents are supplied in a timely manner in order to ensure compliance with provider-based criteria within the expected time requirements from the receipt of the provider’s application. We are including the provider-based designation checklist and list of key documentation on our website as a source for providers to use as a guide to know the exact documentation necessary to make the review process more efficient and to achieve their expected determination.
Below is a link to the list of key documentation.