CMS Announces Revisions to Provider Enrollment Process

The Centers for Medicare & Medicaid Services (“CMS”) revised a critical component of the provider enrollment process by announcing that providers will be allowed to submit their enrollment applications sixty (60) days prior to the effective date listed on the application. Under the previous enrollment guidelines, providers could submit their applications no more than thirty (30) days prior to the effective date.

The revision – as announced by CMS in Transmittal 415, Change Request 7797 – will take effect on May 14th. It is important to note that the revision does NOT apply to: (1) providers and suppliers submitting a Form CMS-855A application, (2) ambulatory surgical centers (ASCs), or (3) portable x-ray suppliers (PXRSs).

CMS stated that the purpose of Change Request 7797 was to continue the process of updating Chapter 15 of the Medicare Program Integrity Manual (“PIM”), with particular emphasis on the sections dealing with application returns and rejections. Under the old guidelines, Medicare contractors would return any and all enrollment applications which were submitted more than thirty days prior to the effective date, thus further complicating an already time-sensitive process. Change Request 7797 signals an attempt to improve and streamline the provider enrollment process.

If you have any questions regarding Transmittal 415, Change Request 7797, or any other compliance-related issue(s), please feel free to contact me at .

Best regards,
Andre Perrotta, Esq.
Chief Compliance Officer