The Centers for Medicare & Medicaid Services (CMS) issued a new rule Friday that will further help ensure that Medicare pays health care providers and suppliers accurately and appropriately and will help to protect Medicare from fraud and abuse.
The final regulation makes Medicare enrollment requirements more uniform so a health care provider or supplier can bill Medicare most efficiently. The rule standardizes existing Medicare enrollment requirements that have been used by the various Medicare contractors that process and pay Medicare claims.
“By standardizing the information that a health care provider or supplier must use in order to bill Medicare, we will be better able to protect the Medicare program and assure providers and suppliers that they will be paid promptly,” said, Timothy B. Hill, Chief Financial Officer and Director, Office of Financial Management at CMS. “The new rule will also help bring us even closer to the development of an electronic medical record.”
Moreover, the regulation elaborates on CMS’ existing authorities to deny or revoke an enrollment application. Specifically, this regulation requires that providers and suppliers:
- Complete and submit a Medicare enrollment application to participate in the Medicare program,
- Report changes in enrollment data for most providers and suppliers within 90 days of the change (and within 30 days for durable medical equipment prosthetics and orthotics suppliers) , and
- Require providers and suppliers to re-certify the accuracy of their enrollment information every 5 years.
While one of the primary requirements of this rule is that all providers and suppliers (both new and those already in the program) complete the CMS-855 Medicare enrollment application, existing providers and suppliers are not required to take any action at this time. CMS will notify the provider or supplier when it is time to re-certify their Medicare enrollment information.
In addition to publishing this regulation, CMS anticipates issuing revisions to the existing CMS-855 Medicare enrollment applications in the near future. The revised enrollment applications simplify the enrollment process and make it easier for providers and suppliers to complete and submit an enrollment application to Medicare.
For additional information regarding the Medicare enrollment process, visit Medicare’s provider enrollment web site at cms.hhs.gov/MedicareProviderSupEnroll.