CMS Grants Medicare Provider Enrollment Relief

As the single largest payor for health care in the United States, the Centers for Medicare & Medicaid Services (CMS) has recognized and acted on the need to move quickly in the fight against COVID-19.  The agency’s ability to respond was bolstered following the declaration of a national emergency, which triggered the availability of new tools for its use under Section 1135 of the Social Security Act.  In order to expand available medical services, CMS is seeking to increase the number of providers eligible for Medicare reimbursement by temporarily loosening provider enrollment requirements for Part A and Part B providers.  CMS recently released an FAQ titled “2019-Novel Coronavirus (COVID-19) Medicare Provider Enrollment Relief Frequently Asked Questions,” which provides greater clarity to applicants and providers impacted by changes to enrollment.  Highlights include:

How is CMS using its authority under Section 1135 of the Social Security Act to offer flexibilities with Medicare provider enrollment to support the 2019-Novel Coronavirus (COVID-19) national emergency?

CMS is exercising its 1135 waiver authority in the following ways:

  • Providers and Suppliers other than Practitioners (including DMEPOS)
    • Expedite any pending or new applications
      • All clean web applications will be processed within 7 business days and all clean paper applications in 14 business days
    • Waive the following screening requirements for all enrollment applications received on or after March 1, 2020:
      • Application Fee – 42 C.F.R. 424.514
      • Criminal background checks associated with the FCBC – 42 C.F.R. 424.518 (to the extent applicable)
      • Site-visits – 42 C.F.R. 424.517
      • Postpone all revalidation actions
  • Physicians and Non-Physician Practitioners
    • Establish toll-free hotlines to enroll and receive temporary Medicare billing privileges
    • Waive the following screening requirements:
      • Criminal background checks associated with fingerprint-based criminal background checks (FCBC) – 42 C.F.R 424.518 (to the extent applicable)
      • Site visits – 42 C.F.R 424.517
      • Postpone all revalidation actions

What are the COVID-19 Medicare Provider Enrollment Hotlines?

CMS has established toll-free hotlines at each of the Medicare Administrative Contractors (MACs) to allow physicians and non-physician practitioners to initiate temporary Medicare billing privileges. The hotlines should also be used if providers/suppliers have questions regarding the other provider enrollment flexibilities afforded by the 1135 waiver. The hotlines can also be used for physicians and non-physician practitioners to report a change in practice location.

How long will it take the Medicare Administrative Contractor (MAC) to approve my temporary Medicare billing privileges?

The Medicare Administrative Contractor (MAC) will attempt to screen and enroll the physician or non-physician practitioner over the phone and will notify the physician or non-physician practitioner of their approval or rejection of temporary Medicare billing privileges during the phone conversation. The MAC will follow up with a letter via email to communicate the approval or rejection of the physician or non-physician practitioner’s temporary Medicare billing privileges. Note: Physicians and non-physician practitioners who do not pass the screening requirements will not be granted temporary Medicare billing privileges and cannot be paid for services furnished to Medicare beneficiaries.

I am not a physician or non-physician practitioner. Can I use the enrollment hotline to submit my initial enrollment or change of information?

All other providers and suppliers, including DMEPOS suppliers are required to submit initial enrollments and changes of information via the appropriate CMS-855 application. Your MAC will expedite their processing of these applications if received on or after March 1, 2020. Specifically, all clean web applications received on or after March 18, 2020, will be processed within 7 business days, and all clean paper applications received on or after March 18, 2020, will be processed in 14 business days. CMS encourages providers to submit their applications via Internet-Based PECOS.

I have an application pending with the MAC that was submitted prior to March 1, 2020. When will it be approved?

Pending applications for all providers and suppliers received prior to March 1, 2020 are being processed in accordance with existing processing time frames. Generally, web applications are processed within 45 days and paper applications within 60 days.

Before the COVID-19 emergency, CMS had for years been focusing on increasing enrollment requirements, for example by implementing new rules that increase scrutiny on proposed providers.  Given the impact of COVID-19, CMS recognized the need to make reimbursement available to as many providers as possible.  Providers should note, however, that the framework for reimbursement has not changed and that most conditions for participation and payment remain in effect.  Providers should keep up-to-date on CMS’ response to COVID-19 and updates to enrollment policies, including new guidance issued after the COVID-19 emergency.  While enrollment requirements have temporarily been reduced to address the novel disease, it is not entirely clear how or when CMS will return to its pre-emergency enrollment process and revisit enrollments approved during the COVID-19 outbreak.

For more information, please contact Hedy S. Rubinger or Alexander B. Foster.