JO - Health Care Compliance Association

By John J. Eller, Esq, and Donna J. Senft, Esq.
John J. Eller
Editor’s Note: John J. Eller is a principal
and Donna J. Senft is an associate at
Ober Kaler, a Baltimore law firm serving
business, commercial finance, construction,
health, and litigation. Mr. Kaler can be
reached at jjeller@ober.com or 410/347-
7362; Ms. Senft can be reached at djsenft@
ober.com or 410/347-7336.
On April 21, 2006, the Centers for
Medicare and Medicaid Services
(CMS) published its final rule,
“Medicare Program: Requirements for
Providers and Suppliers to Establish and
Maintain Medicare Enrollment,” which made
changes to the existing Medicare rules that
significantly affect existing providers and
suppliers, as well as new enrollees. Although
providers and suppliers have always been
required to comply with the Medicare enrollment
rules, both for initial enrollment and
on a continuing basis thereafter, the new
rules require that at some point in the near
future, every provider or supplier will need to
have a complete CMS 855 form on record.
The new requirements contain procedural
safeguards for CMS to verify that a provider
or supplier is compliant with the enrollment
requirements, and also contain significant
sanctions for non-compliance. Understanding
and adhering to the requirements is, therefore,
not only important for a provider or
supplier to ensure that initial enrollment is
expeditiously obtained, but also critical to
help ensure that its Medicare enrollment
remains activated without interruption or the
imposition of sanctions.
The changes contained in the final rule, published
just days before the end of the three-year
time period to implement the proposed rule
that was published on April 25, 2003, became
effective June 20, 2006. They are the latest in a
series of initiatives to strengthen the Medicare
enrollment process to prevent initial or continued
enrollment by unqualified or fraudulent
providers or suppliers. Prior initiatives included
contracting with the National Supplier Clearinghouse
(NSC) regarding initial or continued
enrollment of durable medical equipment,
prosthetic, and orthotics suppliers (DMEPOS)
and authorizing fiscal intermediaries and
carriers to conduct site visits to verify if the
provider or supplier was eligible to participate
in the Medicare program.
Just as providers and suppliers were learning
about the new requirements contained in the
final rule, on May 1, 2006, CMS released
revised enrollment forms, (i.e., the CMS
855 series) used by providers and suppliers
to apply for initial enrollment and to request
changes to the enrollment file. A one-month
grace period was established, with providers
and suppliers required to use the new forms
for any submission after June 2, 2006. The
following are direct Internet links to the all of
the new enrollment forms:
CMS 855A for Institutional Providers:
www.cms.hhs.gov/cmsforms/downloads/
cms855a.pdf
CMS 855B for Clinics/Group Practices and
Certain Other Suppliers:
www.cms.hhs.gov/CMSforms/downloads/
cms855b.pdf
CMS 855I for Physicians and Non-Physician
Practitioners:
www.cms.hhs.gov/cmsforms/downloads/
cms855i.pdf
CMS 855R for Reassignment of Medicare
Benefits:
www.cms.hhs.gov/cmsforms/downloads/
cms855r.pdf
CMS 855S for DMEPOS Suppliers:
www.cms.hhs.gov/cmsforms/downloads/
cms855s.pdf
Key provisions of the final rule
New enrollment forms completion
From the inception of the CMS 855 forms in
1997, providers or suppliers who were already
enrolled in the Medicare program did not
have to complete and submit the entire CMS
855 application form. With the release of the
new versions of the CMS 855 forms, CMS
will require all providers and suppliers--- even
September 2006
24
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