Be Prepared for Medicare NPE Validation Visits – Part 5: Handling Issues
By: Kris Ravotti, RRT, RCP
Clinical Compliance Educator
Posted: October 1, 2025
The last installment of our series about NPE validation visits explores what happens after your site visit and steps to take if something doesn’t go to plan.
NPE site visit findings
If you receive a PTAN revocation letter based on the outcome of an NPE site visit, it will include instructions for submitting a corrective action plan (CAP) or a reconsideration request. Only providers that are revoked for noncompliance under 42 CFR 424.535(a)(1) are entitled to submit a CAP.
It is important to follow the instructions and timelines listed in the letter with a timely, detailed, and specific response. There are no appeal rights when a CAP is submitted but there are appeal rights for reconsideration requests.
Remember that the PTAN revocation will be effective 30 days from the postmark on the revocation letter. So, even though CAPs must be received by the NPE contractor within 35 days and reconsideration requests within 65 days, your ability to submit claims will end in 30 days. Do not delay in responding!
Because the loss of a PTAN can have long-standing financial and operational effects on the provider, consider seeking aid from attorneys or others experienced in responding to revocation letters when submitting your response.
NPE site visit contractor issues
The National Supplier Clearing House Advisory Committee (NSCAC) is an organization of individuals representing DME MAC Jurisdiction Advisory Committees/Councils. NSCAC is the problem–solving/communication link between DMEPOS suppliers and the NPEs. The committee holds quarterly meetings with NPE East and West.
With increased scrutiny of site visits, many suppliers are noting issues with contracted inspectors. To report issues with East and/or West inspectors who visit your site, complete the Site Inspection Tracking Form.
If you experience challenges and/or major delays with Chags Health Information Technology (C-HIT) LLC, the contractor responsible for enrollment appeals and rebuttals, report those issues by completing the Appeals & Rebuttals Tracking Form.
Both of these forms are Google docs. Documenting issues with site inspections and/or appeals and rebuttals is the only way that NSCAC can get them addressed with CMS.
Previous articles in this series can provide additional insights on NPE validation visits. Click titles of individual articles here to access: Part 1, Validation Visits; Part 2, Preparing for Success; Part 3, Complaint Procedures; and Part 4, Physical Location Requirements.
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