Medicare proposes new enrollment policy

Sunday, April 27, 2003

April 28, 2003

BALTIMORE - Medicare announced last week that it is proposing a new enrollment policy to simplify requirements and ensure that only qualified health-care providers and suppliers are enrolled in Medicare.

CMS proposed a new regulation defining procedures for a provider or supplier to establish and maintain its Medicare billing privileges.

"Streamlining the enrollment process is part of our broader strategy to simplify and clarify Medicare requirements," HHS Secretary Tommy G. Thompson said. "By making the process simpler, we will make it easier for qualified health care providers, including doctors, and suppliers to better serve Medicare beneficiaries, while ensuring that unqualified ones do not."

The proposed regulation will consolidate enrollment criteria and ensure consistency in the process. The criteria to qualify and maintain Medicare billing privileges include:

* Applicants have to be fully qualified and must meet all federal, state and local licensure requirements for providing their services.

* If applicants, including owners, managers or directors, have been excluded or sanctioned by the Medicare program or debarred by any other federal program, they will not be approved for Medicare enrollment.

* Any enrolled provider or supplier that does not bill the program for two consecutive quarters will be deactivated until they have active bills.

* CMS will require Medicare providers and suppliers to re-certify the accuracy of their enrollment information every three years.