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MEDICARE PROPOSES NEW ENROLLMENT POLICY FOR HEALTH-CARE PROVIDERS AND SUPPLIERS

Medicare today announced it is proposing a new enrollment policy that will simplify requirements and continue to ensure that only qualified health-care providers and suppliers are enrolled in Medicare.

The Centers for Medicare & Medicaid Services (CMS), which administers Medicare, proposed a new regulation defining procedures for a provider or supplier to establish and maintain its Medicare billing privileges.

"Streamlining the enrollment process is part of our broader strategy to simplify and clarify Medicare requirements," HHS Secretary Tommy G. Thompson said.   "By making the process simpler, we will make it easier for qualified health care providers, including doctors, and suppliers to better serve Medicare beneficiaries, while ensuring that unqualified ones do not." 

In developing this initiative, CMS consulted with providers, suppliers and health care associations.   CMS will publish the provider enrollment regulation tomorrow in the Federal Register and ask for public comment on the regulation for 60 days following publication.

"CMS has taken a big step forward to ensure that only qualified providers and suppliers provide services to Medicare beneficiaries, but we need to do more," CMS Administrator Tom Scully said.  "The Medicare program must be modernized and strengthened so that we provide the health care needed by the elderly and people with disabilities."

The proposed regulation will consolidate enrollment criteria and ensure consistency in

the process.  The criteria to qualify and maintain Medicare billing privileges include:

• Applicants have to be fully qualified and must meet all federal, state and local licensure requirements for providing their services. 

• If applicants, including owners, managers or directors, have been excluded or sanctioned by the Medicare program or debarred by any other federal program, they will not be approved for Medicare enrollment.

• Any enrolled provider or supplier that does not bill the program for two consecutive quarters will be deactivated until they have active bills.  There will be special considerations for those who bill Medicare infrequently, such as pediatricians and providers who do mass immunizations.

• CMS will require Medicare providers and suppliers to re-certify the accuracy of their enrollment information every three years.

In November 2001, CMS revised the CMS 855 Provider/Supplier Enrollment Application to further ease the enrollment of qualified providers and suppliers into Medicare.  The application is actually a set of four individualized forms, each geared toward a specific provider or supplier type based on the applicant. These forms are being published concurrently with the proposed rule to allow review and comment on the complete enrollment process.