Medicare Announces Charging for Enrollment

Medicare will start charging fees for some enrollment applications

Wow, I’m not sure why this surprised me so much but when I saw this email I was surprised. Medicare is going to start charging providers who submit enrollment applications? Well it’s not all providers, but still it is going to affect many. But the CMS (Centers for Medicare and Medicaid Services) announced that effective Friday, March 25, 2011 Medicare Administrative Contractors will begin collecting application fees for certain provider/supplier enrollment applications. This is for both paper and online, or PECOS, applications.

How much will this application fee be? That is the first question I had. But the answer is not clear. There is a published document at http://www.GPO.gov/fdsys/pkg/FR-2011-02-02/pdf/2011-1686.pdf but it was a little difficult to wade thru all 110 pages. It appears that they are charging $500 for new enrollments for 2010 but since it wasn’t effective until March of 2011 I was left a little perplexed. Anyway, it looks like the fee for 2011 is $512 for new enrollments and $200 for revalidations and/or adding practice locations.

Also, the fee is not applicable to all providers. The fees do not apply to physicians, non-physician practitioners, physician organizations, and non-physician organizations. It is only applicable for institutional providers of medical or other items or services or suppliers. It is applicable for the CMS-855A, CMS-855B (not including physician and non-physician practitioner organizations), and CMS-855S applications.

Personally, I think this is going to cause some major confusion. As if it wasn’t hard enough for providers to just figure out what forms need to be submitted, now they need to determine if they need to pay. Also, some of the MAC’s (Medicare Administrative Contractors) are already difficult to deal with. (Just for the record, some are very pleasant and helpful.) Now they have another way that they can return apps stating that the fee was not included, even if no fee was needed. As we all know, Medicare being a government agency is full of red tape. If the provider makes a mistake they have to fix it, but if the MAC makes a mistake, the provider still has to fix it.

And I find it very ironic that Medicare is now requiring all providers to accept payments thru EFT (electronic funds transfer) but they are requiring payment for these apps by paper check. They haven’t developed a mechanism yet for receiving payment electronically. Of course they will have exceptions based on hardship but those will be determined on a case by case basis at the discretion of the MAC. I think consistency will be an issue there.

I’m usually a “glass is half full” person and as I read back thru this I feel I’m being quite negative. However, after doing thousands of Medicare applications over the past several years, I have seen many problems in the application process. To me, this addition of a fee is just going to complicate things even more. We’ll be watching to see how it plays out!

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2 Responses to “Medicare Announces Charging for Enrollment”

  1. Linda Carney Says:

    Hi Michelle, It seems anything to do with Medicare nowadays has become a nightmare. Nothing is easy nor can it be done with a simple phone call anymore.
    The doctor I work with has been participating with Medicare for several years but has decided to become non-par this year. Since Jan. I have been trying to get his status changed but it’s been one problem after another. Last week a M/C rep. informed us that we must enroll in the PECOS system first so that we can then un-enroll and become non-par. Are you kidding me? This rep didn’t say anything about any fee for this but you can be sure I’ll keep calling tomorrow until I get an answer. I’ll keep you informed. It’s absolutely ridiculous! Linda

    • solutionsmedicalbilling Says:

      There shouldn’t be a fee if he is a Dr. But they should have advised you that he needed to be in PECOS in order to opt out of participation back when you started! Good luck!


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