Are you a provider enrolled in Medicare Before March 25, 2011?
The Centers for Medicare & Medicaid Services (CMS) is implementing a little known provision of the Affordable Care Act that will affect nearly all Medicare providers, is your company ready?
One of the problems with Medicare is the billions of dollars of fraud committed each year. Some estimate as much as $50 billion annually is wasted by paying fraudulent claims. The Affordable Care Act attempts to address this, and included provisions to deter the “bad guys” from becoming Medicare providers, and beginning March 25, 2011, NEW providers enrolling in Medicare will be categorized into one of three screening categories based on risk of fraud.
The High risk provider types, like Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers, will be subject to an enhanced screening during the enrollment process, which includes site visits. They will be required to pay an enrollment fee which was $505 for 2011.
But what about those already enrolled as Medicare providers? Well CMS (the agency that governs Medicare) recently announced these provisions will be applied to EVERYONE meaning ALL providers will be contacted sometime between now and 2013 by CMS to “revalidate” their enrollment.
A Medicare claims processing contractor will contact you to revalidate your enrollment by submitting a new enrollment form or by using the electronic system called Provider Enrollment, Chain and Ownership System (PECOS).
The application fees and enhanced screening apply to revalidation as well.
For more information, see the CMS Special Edition Article SE1126 at http://www.cms.gov/MLNMattersArticles/downloads/SE1126.pdf.