Medicare Enrollment Guide for Institutional Providers
Medicare Enrollment Guide for Institutional Providers
Become an Institutional Provider
Use this guide if you are enrolling a hospital, critical care facility, skilled nursing facility, home health agency, hospice, or other similar institution.
Provider Enrollment & Certification Roadmap
Learn about each step of the enrollment and certification process for institutional providers at the Provider Enrollment & Certification Roadmap (PDF) with timeframes and points of contacts for each step.
Rural Emergency Hospitals (REHs)
CMS implemented a new REH provider type on Jan. 1, 2023. If you're converting a rural hospital or critical access hospital to an REH, the REH Medicare Provider Instructions (PDF) will give you the information you need to submit your application.
Medicare Enrollment Guide for Institutional Providers
Your institution’s authorized official will need to complete the steps in this enrollment guide. If the authorized official doesn’t have an account with the Identity Access & Management System, they can create one on the Identity Access & Management System website.
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Step 1: Get an NPI
If you already have an NPI, skip this step and proceed to Step 2.
NPIs are issued through the National Plan & Provider Enumeration System (NPPES). You can apply for an NPI on the NPPES website. Not sure if you have an NPI? Search the NPI Registry. Refer to the NPI Fact Sheet (PDF) for more information.
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Step 2: Complete the Medicare Enrollment Application
Enroll using PECOS,i the online Medicare enrollment system. PECOS has video and print tutorials and will walk you through your enrollment to ensure your information is accurate. Complete the online PECOS application. Refer to the PECOS Fact Sheet (PDF) for more information.
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Step 3: Pay the Medicare Application Fee
You can pay the fee on the PECOS Medicare Fee Payment page.
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Step 4: Work With Your MAC and the State Agency
Medicare Administrative Contractors (MACs) process all Medicare applications for institutional providers. After you submit your enrollment application, your MAC will forward your application to the State Agency for the next step in the process.
The State Agency will conduct a review for further compliance with the applicable Federal, State, and local requirements. Once the Stage Agency’s review is complete, they will share the determination with your MAC. Your MAC may order a site visit from the National Site Visit Contractor before a final decision is issued.
You can check your enrollment status using the contacts in the Provider Enrollment & Certification Roadmap (PDF).
Keep Your Information Current
It’s important to keep your enrollment information up to date. To avoid having your Medicare billing privileges revoked, be sure to report the following changes within 30 days:
- a change in ownership
- an adverse legal action
- a change in practice location
You must report all other changes within 90 days. If you applied online, you can keep your information up to date in PECOS. If you applied using a paper application, you’ll need to resubmit your form to update information.
Need Help With Your Enrollment?
Your MAC can help you navigate the enrollment process and answer questions about your application. Contact your MAC (PDF).
i If you’re unable to apply online using PECOS, you can use a paper application form.
ii If your institution has obtained accreditation from a CMS-approved accreditation organization, you will not need to participate in State Survey Agency surveys. You must inform the State Survey Agency that your institution is accredited. Accreditation is voluntary; CMS doesn’t require it for Medicare enrollment. For more information, visit the Accreditation of Medicare Certified Providers & Suppliers page.
Page Last Modified:
12/16/2024 12:31 PM