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CMS Loosens Provider Enrollment Restrictions

CMS Loosens Provider Enrollment Restrictions

The Centers for Medicare & Medicaid Services (CMS) has announced that its scaling back on some restrictions surrounding provider enrollment in the wake of the COVID-19 outbreak. Under Section 1135 of the Social Security Act, CMS is exercising its waiver authority for physicians and non-physician practitioners (NPPs) to help expedite the enrollment process.

Call for Temporary Medicare Billing Privileges

To start, CMS will be establishing toll-free hotlines to enroll and receive temporary Medicare billing privileges. Providers looking to streamline their enrollment should contact the hotline pertaining to the Medicare Administrative Contractor (MAC) respective to their geographic area. CMS will be temporarily waiving the following three screening requirements to get providers enrolled as quickly as possible:

  • Criminal background checks associated with fingerprint-based criminal background checks (FCBC) (to the extent applicable)
  • Site visits
  • Postpone all revalidation actions

MAC hotlines will be open Monday – Friday for inquiries. Provider should have the following information on hand before connecting with a representative:

  • National Provider Identifier (NPI),
  • Social Security Number,
  • A valid in-state or out-of-state license, and
  • Contact information.

Note: Approval or rejection of temporary Medicare billing privileges will be determined during the phone conversation. Additionally, a follow-up email from the respective MAC will sent confirming the approval or rejection.

Providers Must Meet This Set of Criteria

For CMS to authorize the 1135 waiver for a physician or NPP, the following four conditions must be met:

  • The physician or NPP must be enrolled as such in the Medicare program;
  • The physician or NPP must possess a valid license to practice in the state which relates to his or her Medicare enrollment;
  • The physician or NPP is furnishing services – whether in person or via telehealth – in a state in which the emergency is occurring in order to contribute to relief efforts in his or her professional capacity; and
  • The physician or NPP is not affirmatively excluded from practice in the state or any other state that is part of the 1135 emergency area.

Certain Requirements Waived After March 1

With respect to other providers and suppliers (including suppliers), CMS outlines some additional measures for a speedy enrollment. First, CMS will expedite any pending or new applications by processing “clean” web applications within seven business days and “clean” paper applications within 14 business days.
Note: There are no hotlines available for enrollment for providers other than physicians and NPPs. Other providers and suppliers should apply using the appropriate CMS-855 application (via online or by mail).
Furthermore, CMS will waive the following requirements for applications received on or after March 1, 2020:

  • Application Fee,
  • Criminal background checks associated with the FCBC (to the extent applicable),
  • Site visits, and
  • Postpone all revalidation actions.

A list of MAC toll-free enrollment hotlines, in addition to answers to other pertinent FAQs, are given in the “2019-Novel Coronavirus (COVID-19) Medicare Provider Enrollment Relief FAQ.”

Brett Rosenberg

About Has 12 Posts

Brett Rosenberg, MA, CPC, COC, CCS-P, serves as the editor of The Coding Institute’s (TCI’s) Radiology, Otolaryngology, and Outpatient Facility Coding Alerts. He earned his bachelor’s degree in psychology from the University of Vermont in 2011 and his master’s degree in psychology from Medaille College in 2016. Rosenberg is affiliated with the Flower City Professional Coders local chapter in Rochester, N.Y.

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