A. General Background Information
A CORF is a facility established and operated at a single fixed location exclusively for the purpose of providing diagnostic, therapeutic, and restorative services to outpatients by or under the supervision of a physician. Specific examples of such services include:
• Physician services (*)
• Physical therapy (*)
• Occupational therapy
• Respiratory therapy
• Speech pathology
• Social work or psychological services (*)
• Prosthetic/orthotic devices
• Lab services (must meet 42 CFR Part 493 requirements)
(* Services that the CORF must provide)
In addition:
• If the regional office (RO) determines that sufficient functional and operational independence exists, a CORF may be able to share space with another Medicare provider. However, the CORF may not operate in the same space at the same time with another Medicare provider. (See Pub. 100-07, State Operations Manual (SOM), chapter 2, sections 2364 – 2364C for more information.)
• Like most certified providers, CORFs must be surveyed by the State agency and must sign a provider agreement.
• On occasion, an outpatient physical therapy/speech language pathology (OPT/SLP) location might convert to a CORF; prior to enrolling in Medicare, however, it must be surveyed to ensure that the CORF conditions of participation are met.
B. Enrollment
1. Offsite Locations
Notwithstanding the “single fixed location” language cited in subsection A above, there may be isolated cases where the RO permits a CORF to have an offsite location. This typically arises if the CORF wants to provide physical therapy, occupational therapy, or speech language pathology services away from the primary location. (This is permitted under 42 CFR §485.58(e)(2)). The offsite location would not necessarily be separately surveyed, but would be listed as a practice location on the CORF’s Form CMS-855A application.
2. Site Visits
• Initial application – If a CORF submits an initial application, the contractor shall order a site visit through the Provider Enrollment, Chain and Ownership System (PECOS) after the contractor receives the tie-in notice (or approval letter) from the RO but before the contractor conveys Medicare billing privileges to the CMHC. This is to ensure that the provider is still in compliance with CMS’s enrollment requirements. The scope of the site visit will be consistent with section 15.19.2.2(B) of this chapter. The National Site Visit Contractor (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.
• Revalidation – If a CORF submits a revalidation application, the contractor shall order a site visit through PECOS. This is to ensure that the provider is still in compliance with CMS’s enrollment requirements. The scope of the site visit will be consistent with section 15.19.2.2(B) of this chapter. The NSVC will perform the site visit. The contractor shall not make a final decision regarding the revalidation application prior to the completion of the NSVC’s site visit and the contractor’s review of the results.
• New/changed location - If a CORF 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 after the contractor receives notice of approval from the RO but before the contractor switches the provider’s enrollment record to “Approved.” This is to ensure that the new/changed location is in compliance with CMS’s enrollment requirements. The scope of the site visit will be consistent with section 15.19.2.2(B) of this chapter. The NSVC will perform the site visit. The contractor shall not switch the provider’s enrollment record to “Approved” prior to the completion of the NSVC’s site visit and the contractor’s review of the results.
For more information on CORFs, refer to:
• Section 1861(cc) of the Social Security Act
• 42 CFR Part 485, Subpart B
• Pub. 100-07, chapter 2, sections 2360 – 2366 (SOM)
• Pub. 100-07, chapter 3, section 3224 (SOM)
• Pub. 100-07, Appendix K (SOM)
• Pub. 100-02, chapter 12 (Benefit Policy Manual)
See also sections 15.19.2.2 through 15.19.2.4 of this chapter for additional CORF site visit information.
A CORF is a facility established and operated at a single fixed location exclusively for the purpose of providing diagnostic, therapeutic, and restorative services to outpatients by or under the supervision of a physician. Specific examples of such services include:
• Physician services (*)
• Physical therapy (*)
• Occupational therapy
• Respiratory therapy
• Speech pathology
• Social work or psychological services (*)
• Prosthetic/orthotic devices
• Lab services (must meet 42 CFR Part 493 requirements)
(* Services that the CORF must provide)
In addition:
• If the regional office (RO) determines that sufficient functional and operational independence exists, a CORF may be able to share space with another Medicare provider. However, the CORF may not operate in the same space at the same time with another Medicare provider. (See Pub. 100-07, State Operations Manual (SOM), chapter 2, sections 2364 – 2364C for more information.)
• Like most certified providers, CORFs must be surveyed by the State agency and must sign a provider agreement.
• On occasion, an outpatient physical therapy/speech language pathology (OPT/SLP) location might convert to a CORF; prior to enrolling in Medicare, however, it must be surveyed to ensure that the CORF conditions of participation are met.
B. Enrollment
1. Offsite Locations
Notwithstanding the “single fixed location” language cited in subsection A above, there may be isolated cases where the RO permits a CORF to have an offsite location. This typically arises if the CORF wants to provide physical therapy, occupational therapy, or speech language pathology services away from the primary location. (This is permitted under 42 CFR §485.58(e)(2)). The offsite location would not necessarily be separately surveyed, but would be listed as a practice location on the CORF’s Form CMS-855A application.
2. Site Visits
• Initial application – If a CORF submits an initial application, the contractor shall order a site visit through the Provider Enrollment, Chain and Ownership System (PECOS) after the contractor receives the tie-in notice (or approval letter) from the RO but before the contractor conveys Medicare billing privileges to the CMHC. This is to ensure that the provider is still in compliance with CMS’s enrollment requirements. The scope of the site visit will be consistent with section 15.19.2.2(B) of this chapter. The National Site Visit Contractor (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.
• Revalidation – If a CORF submits a revalidation application, the contractor shall order a site visit through PECOS. This is to ensure that the provider is still in compliance with CMS’s enrollment requirements. The scope of the site visit will be consistent with section 15.19.2.2(B) of this chapter. The NSVC will perform the site visit. The contractor shall not make a final decision regarding the revalidation application prior to the completion of the NSVC’s site visit and the contractor’s review of the results.
• New/changed location - If a CORF 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 after the contractor receives notice of approval from the RO but before the contractor switches the provider’s enrollment record to “Approved.” This is to ensure that the new/changed location is in compliance with CMS’s enrollment requirements. The scope of the site visit will be consistent with section 15.19.2.2(B) of this chapter. The NSVC will perform the site visit. The contractor shall not switch the provider’s enrollment record to “Approved” prior to the completion of the NSVC’s site visit and the contractor’s review of the results.
For more information on CORFs, refer to:
• Section 1861(cc) of the Social Security Act
• 42 CFR Part 485, Subpart B
• Pub. 100-07, chapter 2, sections 2360 – 2366 (SOM)
• Pub. 100-07, chapter 3, section 3224 (SOM)
• Pub. 100-07, Appendix K (SOM)
• Pub. 100-02, chapter 12 (Benefit Policy Manual)
See also sections 15.19.2.2 through 15.19.2.4 of this chapter for additional CORF site visit information.
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