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CMS Revises Reporting Requirements for Physicians, Nonphysician Practitioners, and Suppliers
LEGAL COLUMN
Howard J. Sollins
Donna J. Senft
Susan A. Turner
CMS Revises Reporting Requirements for Physicians, Nonphysician Practitioners, and Suppliers Susan A. Turner, JD In early January 2009, the Centers for Medicare and Medicaid Services (CMS) announced revisions to the existing reporting requirements for physicians, nonphysician practitioners (such as nurse practitioners and physician’s assistants), and health care suppliers who are enrolled in the Medicare program. Although the January 2009 announcement did not change the existing requirement that practitioners or suppliers already enrolled in the Medicare program report changes in their enrollment information to their Medicare intermediary or carrier, this announcement does clarify that certain events are, in fact, reportable, gives deadlines by which time certain events must be reported, and clarifies the process by which practitioners should report these changes. CMS advises practitioners that reporting changes as soon as possible will help to ensure that claims are processed correctly because certain of the newly clarified reportable events may affect claims processing, a payment amount, or even a practitioner’s eligibility to participate in the Medicare program. The new guidelines advise physicians, nonphysician practitioners, and suppliers that a Change in Ownership or Control is required to be reported as soon as possible, but no later than 30 days after the change. CMS must be notified whenever there is a change of 5% or more in the direct or indirect ownership of the Medicare-enrolled entity, or if there is a change in the controlling interest of the entity. An ownership interest is defined as possessing stock, equity in capital, or an interest in the profits of the Medicare entity. A controlling interest is defined as being able to direct or manage the Medicare entity, such as the ability to sell assets of the entity, name members of the board, or amend the bylaws of the entity. Under these new guidelines, physicians, nonphysician practitioners, and Independent
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Diagnostic Testing Facilities (IDTFs) are required to report the following events as soon as possible, but no later than 30 days after the reportable event. Suppliers other than IDTFs must report these events no later than 90 days after the event: Change in Practice Location CMS must be notified when a practitioner establishes a new practice location, moves an existing practice location, closes an existing practice location, or changes any portion of an address of an existing practice location address where Medicare information is sent. Change in Final Adverse Action CMS must be notified when a practitioner is debarred or excluded by any federal or state health care program, has his or her medical license suspended or revoked by a state licensing authority, was convicted of a felony within the previous 10 years, has his or her Medicare billing privileges revoked by a Medicare contractor, or has a revocation or suspension by an accreditation organization. Physicians, nonphysician practitioners, and suppliers must report these events as soon as possible, but no later than 90 days after the reportable event: Change of Business Structure CMS must be notified when a practitioner changes his or her business structure (e.g., sole proprietorship to sole incorporated owner or vice versa) Change in Organization Legal Business Name/Tax Identification Number CMS must be notified when a business owner changes the organization’s legal business name and/or Taxpayer Identification Number with the Internal Revenue Service. Change in Practice Status CMS must be notified when a practitioner decides to retire or voluntarily withdraw from the Medicare program.
Geriatric Nursing, Volume 30, Number 2
Change in Reassignment of Benefits CMS must be notified when a practitioner adds or voluntarily withdraws his or her reassignment of Medicare benefits. Nonphysician practitioners must report this type of change on the Medicare Enrollment Application for Reassignment of Medicare Benefits (Form CMS-855R). The new guidance reminds us that only individual physicians and nonphysician practitioners can reassign the right to bill the Medicare program. Any Change in Banking Arrangements or any Payment Information should be reported to CMS immediately to avoid delays in payments or deposits to the wrong bank account. CMS advises that a practitioner can update his or her electronic funds transfer information by submitting the electronic funds transfer authorization agreement (CMS-588) to his or her intermediary or carrier. The January 2009 guidance advises that physicians and nonphysician practitioners can make a change in their enrollment information using CMS’s Internet-based Provider Enrollment, Chain and Ownership System (PECOS), or the
Geriatric Nursing, Volume 30, Number 2
paper enrollment application process (such as the applicable CMS-855 form). The PECOS system is expected to be available to all other providers and suppliers (except durable medical equipment, prosthetics, orthotics, and supplies [DMEPOS] suppliers) later this year. In addition to providing information about reportable events and the deadlines associated with reporting, the January guidance advises nonphysician practitioners who are enrolled in the Medicare program but have not submitted the Medicare Enrollment Application for Physicians and Non-Physician Practitioners (CMS-855I) since 2003 that they must submit a Medicare enrollment application as an initial application when reporting a change for the first time. The application can be submitted using either PECOS or the paper enrollment application process. SUSAN A. TURNER, JD, is a principal in Ober? Kaler’s Health Law Practice Group. 0197-4572/09/$ - see front matter Ó 2009 Mosby, Inc. All rights reserved. doi:10.1016/j.gerinurse.2009.01.006
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Howard J. Sollins
Donna J. Senft
Susan A. Turner
CMS Revises Reporting Requirements for Physicians, Nonphysician Practitioners, and Suppliers Susan A. Turner, JD In early January 2009, the Centers for Medicare and Medicaid Services (CMS) announced revisions to the existing reporting requirements for physicians, nonphysician practitioners (such as nurse practitioners and physician’s assistants), and health care suppliers who are enrolled in the Medicare program. Although the January 2009 announcement did not change the existing requirement that practitioners or suppliers already enrolled in the Medicare program report changes in their enrollment information to their Medicare intermediary or carrier, this announcement does clarify that certain events are, in fact, reportable, gives deadlines by which time certain events must be reported, and clarifies the process by which practitioners should report these changes. CMS advises practitioners that reporting changes as soon as possible will help to ensure that claims are processed correctly because certain of the newly clarified reportable events may affect claims processing, a payment amount, or even a practitioner’s eligibility to participate in the Medicare program. The new guidelines advise physicians, nonphysician practitioners, and suppliers that a Change in Ownership or Control is required to be reported as soon as possible, but no later than 30 days after the change. CMS must be notified whenever there is a change of 5% or more in the direct or indirect ownership of the Medicare-enrolled entity, or if there is a change in the controlling interest of the entity. An ownership interest is defined as possessing stock, equity in capital, or an interest in the profits of the Medicare entity. A controlling interest is defined as being able to direct or manage the Medicare entity, such as the ability to sell assets of the entity, name members of the board, or amend the bylaws of the entity. Under these new guidelines, physicians, nonphysician practitioners, and Independent
124
Diagnostic Testing Facilities (IDTFs) are required to report the following events as soon as possible, but no later than 30 days after the reportable event. Suppliers other than IDTFs must report these events no later than 90 days after the event: Change in Practice Location CMS must be notified when a practitioner establishes a new practice location, moves an existing practice location, closes an existing practice location, or changes any portion of an address of an existing practice location address where Medicare information is sent. Change in Final Adverse Action CMS must be notified when a practitioner is debarred or excluded by any federal or state health care program, has his or her medical license suspended or revoked by a state licensing authority, was convicted of a felony within the previous 10 years, has his or her Medicare billing privileges revoked by a Medicare contractor, or has a revocation or suspension by an accreditation organization. Physicians, nonphysician practitioners, and suppliers must report these events as soon as possible, but no later than 90 days after the reportable event: Change of Business Structure CMS must be notified when a practitioner changes his or her business structure (e.g., sole proprietorship to sole incorporated owner or vice versa) Change in Organization Legal Business Name/Tax Identification Number CMS must be notified when a business owner changes the organization’s legal business name and/or Taxpayer Identification Number with the Internal Revenue Service. Change in Practice Status CMS must be notified when a practitioner decides to retire or voluntarily withdraw from the Medicare program.
Geriatric Nursing, Volume 30, Number 2
Change in Reassignment of Benefits CMS must be notified when a practitioner adds or voluntarily withdraws his or her reassignment of Medicare benefits. Nonphysician practitioners must report this type of change on the Medicare Enrollment Application for Reassignment of Medicare Benefits (Form CMS-855R). The new guidance reminds us that only individual physicians and nonphysician practitioners can reassign the right to bill the Medicare program. Any Change in Banking Arrangements or any Payment Information should be reported to CMS immediately to avoid delays in payments or deposits to the wrong bank account. CMS advises that a practitioner can update his or her electronic funds transfer information by submitting the electronic funds transfer authorization agreement (CMS-588) to his or her intermediary or carrier. The January 2009 guidance advises that physicians and nonphysician practitioners can make a change in their enrollment information using CMS’s Internet-based Provider Enrollment, Chain and Ownership System (PECOS), or the
Geriatric Nursing, Volume 30, Number 2
paper enrollment application process (such as the applicable CMS-855 form). The PECOS system is expected to be available to all other providers and suppliers (except durable medical equipment, prosthetics, orthotics, and supplies [DMEPOS] suppliers) later this year. In addition to providing information about reportable events and the deadlines associated with reporting, the January guidance advises nonphysician practitioners who are enrolled in the Medicare program but have not submitted the Medicare Enrollment Application for Physicians and Non-Physician Practitioners (CMS-855I) since 2003 that they must submit a Medicare enrollment application as an initial application when reporting a change for the first time. The application can be submitted using either PECOS or the paper enrollment application process. SUSAN A. TURNER, JD, is a principal in Ober? Kaler’s Health Law Practice Group. 0197-4572/09/$ - see front matter Ó 2009 Mosby, Inc. All rights reserved. doi:10.1016/j.gerinurse.2009.01.006
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