Ensure Your Institution Knows the Medicare Enrollment Process

by Judith L. Kares, JD

Providers, including institutional providers, must generally be enrolled in the Medicare Fee-for-Service Program (sometimes referred to as “Original Medicare”) in order to receive payment for otherwise covered Medicare services. The relevant enrollment requirements may vary, depending upon the type of provider. Our current institutional Medicare Boot Camp® classes do not specifically cover enrollment, since most participant facilities are already enrolled. Nevertheless, we sometimes receive related questions. CMS recently released an updated fact sheet entitled “Medicare Enrollment for Institutional Providers,” which is available through the Medicare Learning Network®. The updated fact sheet provides comprehensive information on the institutional enrollment process, including the key components discussed below.

Institutional providers

The “institutional providers” subject to Medicare enrollment requirements are listed on CMS Form 855A and include the following:

• Community mental health centers;
• Comprehensive outpatient rehabilitation facilities;
• Critical access hospitals;
• End-stage renal disease facilities;
• Federally Qualified Health Centers;
• Histocompatibility laboratories;
• Home health agencies;
• Hospice organizations;
• Hospitals;
• Indian Health Service facilities;
• Organ procurement organizations;
• Outpatient physical therapy/occupational therapy/speech-language pathology services;
• Religious non-medical healthcare institutions;
• Rural health clinics; and
• Skilled nursing facilities.

CMS advises providers who are uncertain as to whether they fall within one of the above categories to contact their Medicare enrollment contractor before submitting a Medicare enrollment application.  Contact information for Medicare enrollment contractors is available at https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/Downloads/contact_list.pdf.

Four-step process

1. Obtaining a National Provider Identifier (NPI). Institutional providers must obtain an NPI before enrolling in the Medicare Program. They may do so in one of three ways:
2. Overview of the Medicare enrollment application and survey process, as applicable.
3.  Awaiting completion of application process. This portion of the process involves the following four steps:
4. Keeping enrollment information up to date.

CMS has implemented an ongoing revalidation process. All enrolled providers and suppliers must revalidate their enrollment information on a periodic basis, but only after receiving notification from their Medicare enrollment contractor. Providers should not submit a revalidation until notified by their Medicare enrollment contractor. Providers are encouraged to use PECOS to submit their revalidation information. 

            For related information on revalidation, providers may refer to the following:

• Medicare Provider-Supplier Enrollment: Revalidations https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/Medicare ProviderSupEnroll/Revalidations.html
• MLN Matters® Special Edition Article SE1126, “Further Details on the Revalidation of Provider Enrollment Information” https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network- MLN/MLNMattersArticles/Downloads/SE1126.pdf

To view the complete article that appeared on Medicare Compliance Watch, click here.