CMS Proposes New Enrollment
Policy for Health Care Providers
May 30, 2003 - The Centers for Medicare and Medicaid
Services (CMS) April 25 issued a notice of proposed rulemaking
(NPRM) on "Requirements for Establishing and Maintaining
Medicare Billing Privileges" [68
Federal Register 22063]. Overall the NPRM relates
to the 855 forms that physicians and other providers must
complete in order to receive a Medicare Identification Number.
There are five new enrollment forms: (1) Form CMS 855A-for
providers billing fiscal intermediaries; (2) CMS 855B-for
supplier organizations (including group practices) billing
carriers; (3) CMS 855I-for individual health care practitioners
billing carriers; (4) CMS855R-for individual health care practitioners
to reassign benefits to an organization; and (5) Form CMS
855S-for durable medical equipment suppliers billing the NSC.
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.
Comments on the proposed rule are due by June 24. The AAMC
will be submitting detailed comments and concerns about the
provisions of the NPRM to CMS.
Information:
Denise Dodero, Associate Vice President
AAMC Health Care Affairs
ddodero@aamc.org
(202) 828-0493
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