Medicare provider enrollment enables healthcare providers to register with the Centers for Medicare & Medicaid Services (CMS) to be eligible for reimbursement for services provided to Medicare beneficiaries. This process involves submitting various forms and documents to demonstrate compliance with CMS regulations and standards. We’ll cover recent updates to this process and strategies to stay compliant with enrollment and revalidation.

Overview of Medicare and Medicaid Provider Enrollment

Medicare provider enrollment is necessary for healthcare providers who wish to bill this federal health insurance program for services rendered to eligible beneficiaries. The enrollment process involves submitting an application with supporting documentation to CMS. This process verifies that the provider meets the necessary qualifications and standards to participate in these programs.

Recent Updates in Provider Enrollment Policies

CMS has recently introduced several significant changes to enhance program integrity and transparency in the provider enrollment process. Some of the key updates include:

1. Expansion of the 36-Month Rule

This rule, which previously applied only to home health agencies, now includes hospice providers. This expansion aims to prevent the "flipping" of facilities shortly after enrollment.

2. Revised CMS Form 855A

CMS has updated this form for the first time in twelve years to capture new requirements. The changes include:

• Updates for enrolling Rural Emergency Hospitals (REH) and Opioid Treatment Programs.
• New fingerprinting requirements for high-risk providers.
• Administrative updates such as accepting e-signatures.

3. Increased Scrutiny for New Enrollees

New hospice enrollees are now categorized as "high-risk," which means they are subject to extensive background checks, including fingerprinting for owners with significant ownership interest.

Important Changes to Your CMS-855 Enrollment Information

Updating your CMS-855 enrollment information is crucial when making changes under your current tax identification number. Refer to the CMS Medicare Program Integrity Manual (PIM) Chapter 15 for guidance. Key points include:

• Report Changes within 90 Days: Except for certain specified changes, update your enrollment data within 90 days of the effective date.
  • Specific Changes Due Within 30 Days:
    • Change of Ownership
    • Adverse Legal Action
    • Practice Location

Refer to 42 C.F.R. 424.516(e) and the CMS Provider Integrity Manual for detailed instructions.

Best Practices for Provider Enrollment in the Current Landscape

To navigate the evolving provider enrollment landscape successfully, healthcare businesses should:

• Stay informed about updates and changes to enrollment policies and procedures.
• Maintain accurate and up-to-date enrollment information.
• Respond promptly to revalidation requests and notices.
• Utilize available resources and partner with experts to ensure compliance and efficiency.

As Medicare provider enrollment requirements keep changing, it's crucial for healthcare businesses to stay on top of these updates and adapt quickly. Keeping informed about the latest changes, using best practices, and working with experienced professionals can help providers smoothly navigate the enrollment process and stay compliant with CMS regulations.

Lutz Offers Healthcare Provider Enrollment Services

At Lutz, we understand the complexities of the Medicare and Medicaid provider enrollment process. Our team of experienced professionals offers comprehensive healthcare services to assist you in compliance with CMS regulations, streamlining the enrollment process, and minimizing the risk of potential penalties. If you have questions, please contact us.