Timely Reporting of Provider Enrollment Information Changes

PUBLISHED: Aug 3, 2017
Relevant to: Ambulatory Care, Behavioral Health, Clinical Lab, Community Mental Health Centers, Critical Access Hospitals, Dialysis Facilities, Home Health, Hospice, Hospitals, Long Term Care, Medical Office

In accordance with 42 Code of Federal Regulations (CFR) Section 424.516(d), all physicians, non-physician practitioners (for example, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, certified nurse midwives, clinical social workers, clinical psychologists, registered dietitians or nutrition professionals) and physician and non-physician practitioner organizations must report the following changes in their enrollment information to their Medicare Administrative Contractors (MAC) via the Internet-based Provider Enrollment, Chain and Ownership System (PECOS) or the CMS 855 paper enrollment application within 30 days of the change:

  • A change in ownership
  • An adverse legal action
  • A change in practice location.

All other changes must be reported to the provider’s MAC within 90 days of the change.

Suppliers of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS), must report any changes in information supplied on the enrollment application within 30 days of the change to the National Supplier Clearinghouse (NSC) (42 CFR §424.57(c)(2)).

Independent Diagnostic Testing Facilities must report changes in ownership, location, general supervision, and adverse legal actions to their MAC either online, or via the appropriate CMS-855 form, within 30 calendar days of the change.

All other changes to enrollment information must be reported within 90 days of the change (42 CFR §410.33(g)(2).

All providers and suppliers not previously identified must report any change of ownership, including a change in an authorized or delegated official, within 30 days; and all other informational changes within 90 days (42 CFR §424.516(e)).

It is very important that you comply with these reporting requirements. Failure to do so could result in the revocation of your Medicare billing privileges.

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