Medicare Compliance & Reimbursement

Prompt payment is one goal, feds say.

A rose is a rose--and now Medicare certification is Medicare certification. At least that's the intended effect of a new final rule standardizing the certification process.

The rule aims to eradicate past variances from Medicare contractors that sometimes hamper payment. Proponents also say it will be a plus as electronic health records catch on.

At the most recent Skilled Nursing Facility/ Long-Term Care Open Door Forum, one caller asked the Centers for Medicare & Medicaid Services for clarification on the April 21 rule. What are the rule's implications for SNFs that are Medicare-certified? The question stumped staffers on hand, but CMS has offered clarification in the past.

Here are the rule's key provisions:

• The rule calls for recertification every five years.

• Providers must have a National Provider Identifier (NPI) by that time; they'll be required to include it.

• Providers must report changes in enrollment data within 90 days of the change.

• The rule requires the use of CMS Form 855 for initial enrollment in Medicare as well as recertification, beginning May 1, 2006.

The rule elaborates on CMS' existing authority to deny or revoke an enrollment application.

"By standardizing the information that a health care provider or supplier must use in order to bill Medicare, we will be better able to protect the Medicare program and assure providers and suppliers that they will be paid promptly," says Timothy Hill, chief financial officer and director in the CMS Office of Financial Management in a recent statement.

CMS will notify providers when it is time to recertify their Medicare enrollment information.

For more information regarding the new rule, go to www.cms.hhs.gov/MLNMattersArticles/downloads/SE0632.pdf.