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March 4, 2011

The Centers for Medicare and Medicaid Services (CMS) has issued a notice regarding requirements for enrolling and revalidating providers and suppliers. Under the Affordable Care Act and regulations published February 2, CMS will assign enrolling and revalidating providers and suppliers to one of three screening categories. Beginning March 25 providers and suppliers will be assigned to limited, moderate, or high screening categories. For limited screening, the Medicare Administrative Contractor (MAC) will conduct screens similar to the current methodology. Moderate screening will add a site visit to the current review. The high screening category will include the current process, a site visit, and, at some time in the future, a fingerprint-based criminal background check. Some provider and supplier types in each category are:

  • Limited – physicians, non-physician practitioners other than physical therapists, federally-qualified health centers, hospitals, rural health clinics, and skilled nursing facilities;
  • Moderate – community mental health centers, comprehensive outpatient rehabilitation facilities, hospice organizations, clinical laboratories, revalidating home health agencies, and revalidating durable medical equipment, prosthetics/orthotics and supplies (DMEPOS) suppliers; and
  • High – newly-enrolling DMEPOS suppliers, newly-enrolling home health agencies, and providers and suppliers reassigned from limited or moderate categories due to triggering events. Triggering events include payment suspension within 10 years, termination or preclusion from billing Medicaid, exclusion by the Office of the Inspector General, subject of final adverse action as defined by 42 Code of Federal Regulations 424.502 within 10 years, and additional criteria.

Future changes to provider/supplier type assignments will be published in the Federal Register.

CMS also announced that beginning March 25 MACs will collect application fees with enrollment applications for institutional providers and suppliers. The current fee is $505, but will vary with annual adjustment based on the Consumer Price Index for Urban Areas. Institutional providers include those providers or suppliers that submit a paper Medicare enrollment application using the CMS-855A, CMS-855B (but not including physician and non-physician practitioner organizations), CMS-855S, or Internet-based PECOS enrollment applications. Application fees must be submitted by paper check until CMS establishes a process for electronic funds transfers. MACs can grant hardship exceptions on a case-by-case basis. Applications will be rejected if the fee is not submitted or a hardship exception granted.

More information about screening categories and enrollment application fees is available in the February 2, Federal Register.

 

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