Tag Archives: Enrollment

CMS Call to Discuss Streamlined Access to PECOS, EHR, and NPPES (Nov. 15)

On November 15, 2013, CMS is hosting a provider call to discuss recent changes in the way providers and suppliers access the Provider Enrollment Chain and Ownership System (PECOS), the Electronic Health Records (EHR) Incentive Program, and the National Plan and Provider Enumeration System (NPPES).   These updates are intended to facilitate registration as an individual … Continue Reading

OIG Highlights Inaccuracy in Medicare Enrollment Databases

According to the OIG, Medicare provider enrollment databases include inaccurate, incomplete, and inconsistent provider data, and — coupled with insufficient oversight — “present vulnerabilities in all health care programs.” The OIG reviewed heath care provider information maintained in the National Plan and Provider Enumeration System (NPPES) and the Provider Enrollment, Chain and Ownership System (PECOS). … Continue Reading

CMS Delays Phase 2 Ordering and Referring Denial Edits

On April 25, 2013, CMS announced that, due to technical issues, it is delaying implementation of the Phase 2 ordering and referring denial edits until further notice. By way of background, CMS plans to implement edits that will deny claims for Medicare Part B services (including the technical/non-interpretation component of imaging services, lab services, and durable … Continue Reading

Proposed Rule Would Reward Medicare Fraud Tipsters up to $9.9 Million, Revise Medicare Provider Enrollment Regulations

This post was also written by Andrew C. Bernasconi. Yesterday the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would dramatically increase the potential reward to an individual who provides a tip leading to the recovery of Medicare funds from a current maximum of $1,000 to a maximum of $9.9 million under … Continue Reading

Implementation of Medicare Ordering/Referring Provider Edits (March 20 Call)

Effective May 1, 2013, Medicare contractors will activate edits that will deny claims for Medicare Part B (including imaging and lab services), DME, and Part A home health agency (HHA) services if the ordering/referring physician or other professional is not identified, is not in Medicare’s enrollment records, or is not of a specialty type that may … Continue Reading

2013 Medicare Participation Enrollment Period for DMEPOS Suppliers Extended until April 15, 2013

CMS is extending the 2013 Medicare participation enrollment period for suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) until April 15, 2013. By way of background, a supplier that signs a participation agreement commits to accepting the Medicare Part B rate as payment in full for all beneficiaries. Changes in a supplier’s participation … Continue Reading

CMS Issues Revised CMS-855S, 855O Medicare Enrollment Applications

CMS has released the revised CMS-855S Medicare supplier enrollment application, version 01/13. Suppliers may use the 07/11 version of the CMS-855S through May 7, 2013, at which time any information received on the obsolete form will be returned to the supplier, according to the National Supplier Clearinghouse. CMS also has posted an updated (1/13) version of … Continue Reading

Obama Administration’s Regulatory Agenda Points to Busy 2013 for HHS

On January 8, 2013, the Obama Administration published its latest semiannual regulatory agenda, outlining planned regulatory initiatives in a number of policy areas. The Federal Register version of the agenda includes only a portion of the regulations in the pipeline, however; the full agenda has been posted on the Office of Management and Budget (OMB) web … Continue Reading

CMS Announces 2013 Provider Enrollment Application Fee Amount

CMS recently published a notice announcing a $532.00 calendar year 2013 application fee for institutional providers that are initially enrolling in the Medicare or Medicaid program or the Children’s Health Insurance Program (CHIP); revalidating their Medicare, Medicaid or CHIP enrollment; or adding a new Medicare practice location. This fee is required with any enrollment application … Continue Reading

CMS Proposes Revisions to DMEPOS Supplier Application

CMS is proposing changes to the Medicare enrollment application for DMEPOS suppliers (CMS 855S) to simplify and clarify the current data collection and to remove obsolete questions. According to CMS, the majority of the revisions are non-substantive in nature (e.g., spelling and formatting corrections). Comments on the forms will be accepted until June 4, 2012.… Continue Reading

GAO Reviews Medicare Provider/Supplier Screening Efforts

The GAO has issued a report entitled “Medicare Program Integrity: CMS Continues Efforts to Strengthen the Screening of Providers and Suppliers.” The GAO describes how CMS and its contractors use provider and supplier enrollment information to prevent improper payments, along with factors that may affect the usefulness of this information. The report also provides an … Continue Reading

CMS Finalizes Changes in Medicare/Medicaid Provider and Supplier Enrollment, Ordering, Documentation Requirements

CMS published a final rule on April 27, 2012 that updates regulations regarding Medicare and Medicaid provider and supplier enrollment, ordering and referring, documentation requirements, and provider agreements, effective June 26, 2012. The rule modifies and finalizes several ACA provisions implemented in the May 5, 2010 interim final rule with comment period. Among other things, … Continue Reading

CMS Hosts Orlando Symposium on Empowering Minorities (Dec. 14-16)

The CMS Atlanta Regional Office is hosting a symposium in Orlando, Florida on December 14 -16, 2011 entitled “Empowering Minorities — Promoting Better Health, Better Care, Lower Cost for Medicare Beneficiaries in their Communities.” The symposium will feature speakers, panels, and breakout sessions covering a wide range of topics such as Medicare Fraud & Abuse … Continue Reading

CMS Announces $523 Medicare, Medicaid, & CHIP Enrollment Application Fee for 2012

CMS has announced that the 2012 application fee for institutional providers (excluding physicians and nonphysician practitioners) enrolling in Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP) will be $523 – up from $505 in 2011. CMS uses a broad definition of institutional entities subject to the application fee; it applies to “any provider or supplier … Continue Reading

CMS Announces Medicare Providers with Revalidation Requests; Updates EFT Requirement

CMS has posted a list of names/National Provider Identifiers of Medicare providers that have been sent a request to revalidate their Medicare enrollment information. CMS also has announced that as part of its revalidation efforts, all suppliers and providers who are not currently receiving electronic funds transfer (EFT) payments will be identified and required to submit … Continue Reading

Revised Medicare Provider-Supplier Enrollment Application, New Application for Ordering/Referring Released

CMS has announced final approval of revised versions of the Medicare Provider-Supplier Enrollment Applications (CMS-855).  While the revised forms may be used immediately, the previous 2008 versions may be used through October 2011. In addition, CMS has released a new CMS-855O application form to be used for the sole purpose of enrolling to order and refer items and/or … Continue Reading

OIG Examines IDTF Compliance with Medicare Standards

The OIG has issued two new reports that reveal the plans of CMS to conduct more unannounced site visits of independent diagnostic testing facilities (IDTFs) nationally.  The reports describe findings that in Miami and Los Angeles, IDTFs did not comply with Medicare standards requiring IDTFs to: (1) maintain a physical facility at the location on file with … Continue Reading

CMS Sets July 5, 2011 Target for Implementation of PECOS Ordering/Referring Edits

CMS has issued a new transmittal to update its timeline for implementing claims edits that will deny claims for services ordered or referred by a physician or other eligible professional who does not have an approved file in PECOS. The transmittal confirms an earlier CMS list-serve announcement that CMS will not implement the edits (that … Continue Reading

DMEPOS Accreditation Claims Edits

CMS has issued a transmittal to contractors and an educational article providing further guidance to suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) regarding accreditation requirements. Effective for claims with dates of service on or after July 5, 2011, CMS is implementing accreditation edits that will automatically deny claims for certain DMEPOS codes unless: (1) … Continue Reading

CMS Proposes Provider/Supplier Screening Rule

On September 17, 2010,  the Centers for Medicare & Medicaid Services released a proposed rule that would implement provisions of the Affordable Care Act (ACA) that strengthen provider and supplier screening provisions under the Medicare, Medicaid, and Children’s Health Insurance Program (CHIP).  The rule is designed to ensure that “that only legitimate providers and suppliers … Continue Reading