Credentialing & Privileging | 01.23.23
CMS Updates That Impact Provider Enrollment Specialists
2023 is bursting with provider enrollment updates that impact hospitals, durable medical equipment, prosthetics/orthotics & supplies (DMEPOS) organizations and ordering & referring providers. I hope you are as excited as I am to dig right in!
First, Effective Nov. 7, 2022, the National Supplier Clearinghouse (NSC) no longer processes Medicare enrollment applications for DMEPOS suppliers. The National Provider Enrollment DMEPOS East and West contractors now process all DMEPOS enrollment applications. States East of the Mississippi river will be managed by Novitas and states West of the Mississippi River will be managed by Palmetto.
Second, starting December 5, 2022 providers submitting an initial enrollment or providers submitting a Change of Ownership (CHOW) will only be allowed to have one (1) Electronic Funds Transfer (EFT) Accounts and one (1) Special Payments Addresses (SPA).
Third, changes to the CMS Enrollment Form for Medicare Providers who only order or certify services became effective January 1, 2023. Changes to the 855O form includes:
1. New title: Enrollment for Eligible Ordering, Certifying Physicians, and Other Eligible Professionals
previous: Medicare Enrollment Application - Registration For Eligible Ordering and Referring Physicians and Non-Physician Practitioners
2. Revised reporting requirements and formatting in Section 3: Final Adverse Legal Actions;
All applicable final adverse actions must be reported in this section regardless of whether any records were expunged or any appeals are pending.
3. The provider list was updated to add eight (8) new specialties.
Which providers can enroll via the 855O?
Services for Medicare beneficiaries those who are CMS requires certain physicians and eligible professionals (hereafter referred to as providers) to enroll in the Medicare program for the sole purpose of ordering or certifying items or services for Medicare beneficiaries. These providers do not and will not send claims to a Medicare Administrative MAC (MAC) for the services they furnish. The providers who may enroll in Medicare solely for the purpose of ordering and certifying include those listed below.
13 provider types
- Doctors of Medicine or Osteopathy
- Doctors of Dental Medicine
- Doctors of Dental Surgery
- Doctors of Podiatric Medicine
- Doctors of Optometry
- Physician Assistants
- Certified Clinical Nurse Specialists
- Nurse Practitioners
- Clinical Psychologists
- Certified Nurse Midwifes
- Clinical Social Workers
- Licensed Residents (as defined in 42 C.F.R. section 413.75(b)) in an approved medical residency program
- Retired Physicians who are licensed
Finally and this is a big update: Medicare has established Rural Emergency Hospitals (REHs) as a new Medicare provider type to address the growing concern over closures of rural hospitals. The implementation of this new provider type is effective January 1, 2023
A facility is eligible to convert to an REH if it was a Critical Access Hospital (CAH) or rural hospital with not more than 50 beds as of December 27, 2020. REHs must provide emergency services and observation care and are prohibited by the statute from providing inpatient services.
One of the most important REH enrollment provisions in the final rule is that the facility may submit a form CMS-855A, change of information (COI) application (rather than an initial enrollment application), in order to convert from a CAH to an REH. Submitting a COI will expedite the REH enrollment process versus completing a REH initial application.
REHs will be paid for furnishing REH services at a rate that is equal to the OPPS payment rate, for the equivalent covered outpatient department service, increased by 5%. Beneficiaries will not be charged coinsurance on the additional 5% payment.
Application Fee: $688 for an initial application. Note: there is no fee for a COI
Please note the app fee did increase from the 2022 fee $631.00
CMS notes that updates are in direct response to public comments. Colleagues, let’s continue advocating for positive change in our industry and we will make effective and efficient impact in our field.
CMS Fact Sheet:
CMS News Room:
Yesenia Servin is an expert in credentialing and provider/payer enrollment with over 23 years of experience in the healthcare industry. Yesenia has a deep understanding of Medicare & Medicaid enrollment and is a nationally certified credentialing manager and provider enrollment specialist.