CMS Resumes Provider and Supplier Enrollment Activities Paused During Pandemic

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The Centers for Medicare and Medicaid Services (CMS) has started phasing out certain program flexibilities granted during the COVID-19 public health emergency. Beginning in October 2021, CMS will resume several provider and supplier enrollment activities that were paused during the pandemic.

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The Centers for Medicare and Medicaid Services (CMS) indicated in FAQs issued in August 2021 that it will resume several Medicare enrollment activities that were paused during the public health emergency (PHE). The announcement continues the unwinding process for certain flexibilities that CMS afforded providers earlier in the pandemic. CMS will retain some flexibilities that have been established with explicit expiration dates by statute or regulation (typically some period of time after the end of the PHE), but has made clear that not all flexibilities are viewed as essential despite the ongoing pandemic.

The Medicare enrollment activities that will recommence in October 2021 include:

  • Revalidation
  • Application Fees
  • Fingerprint-based criminal background checks.

Revalidation notices under 42 CFR 424.515 will be issued in a phased approach with due dates starting in early 2022. Application fees under 42 CFR 424.514 will be required from institutional providers that are initially enrolling in Medicare, adding a practice or location, or revalidating their enrollment information. Fingerprint-based criminal background checks, in accordance with 42 CFR 424.518, will also resume for “high risk categories of providers and suppliers,” such as newly enrolling home health agencies; opioid treatment programs; and suppliers of durable medical equipment, prosthetics/orthotics and supplies.

The reinstated revalidations, application fees and fingerprint-based criminal background checks will not apply to providers and suppliers that received temporary billing privileges through the Medicare enrollment hotlines during the PHE. After the PHE is lifted, those providers and suppliers will be required to submit a complete CMS-855 enrollment application in order to establish full Medicare billing privileges, at which time application fees and fingerprint-criminal background checks will be required, if applicable.

CMS has indicated that it may resume additional provider enrollment enforcement activities in the coming months. These changes are part of a larger agency movement towards greater program integrity enforcement. In March 2021, CMS announced it would resume onsite visits and surveys of hospitals to verify conditions of participation. Providers should be vigilant to ensure they are not relying on flexibilities that have been discontinued.