CMS Implementation of Provider Enrollment Provisions

The Feb. 2, 2011, edition of the Federal Register included a final rule entitled, “Medicare, Medicaid and Children’s Health Insurance Programs; Additional Screening Requirements, Application Fees, Temporary Enrollment Moratoria, Payment Suspensions and Compliance Plans for Providers and Suppliers.”  The final rule, which took effect March 25, 2011, outlined a number of new requirements for CMS providers and suppliers.

Screening Process:

  • Newly-enrolling and existing providers and suppliers will be placed into one of three levels of screening for risk (limited, moderate or high) when the provider or supplier initially enrolls in Medicare, adds a new practice location, or revalidates enrollment information.
  • Detailed information about the new screening process and the categories can be found in Chapter 15, Section 19.2.1 of the “Program Integrity Manual” (PIM).

Application Fees

  • Providers and suppliers that are initially enrolling in Medicare, adding a practice location, or revalidating their enrollment information must submit an application fee or a request for a hardship exception to the application fee with their application.
  • Physicians, non-physician practitioners, physician group practices and non-physician group practices are not required to pay the application fee unless they are enrolling as a DMEPOS supplier via the CMS-855S application.
  • The fee for March 25, 2011, through Dec. 31, 2011, has been set at $505.00.

Temporary Moratoria

  • Per the above mentioned final rule, CMS may impose a moratorium on the enrollment of new Medicare providers and suppliers of a particular type or the establishment of new practice locations of a particular type in a particular geographic area.
  • Moratoria will be announced via the Federal Register.

For a detailed description of the final rule, please review the Medicare Learning Network MLN Matters article published March 23, 2011.

2011-04-15T00:00:00+00:00 April 15th, 2011|Clinical Resources|