Posted by medpro | Posted in Medical Contracting, Provider Contracting, Provider Enrollment | Posted on 18-04-2011
The CMS has initiated a new provider enrollment fee for selected Medicare suppliers. The fee applies to institutional accounts enrolling for the first time, those re-validating an existing position or ones adding a new practice location. Starting on March 25th 2011, Medicare Administrative Contractors will begin collecting the fees along with a provider’s application. The fee has been set at $505 for the fiscal year 2011. Increases in future years will be based upon inflation, as measured by the Consumer Price Index for Urban areas. These fee adjustments will be effective from January 1st through December 31st. The amount of the fee owed will be based upon the date of the application.
This new fee will apply only to institutional providers of medical or other times, services or suppliers submitting their application using forms CMS-855A or CMS-855B. The fee does not apply to physicians, physician organizations or non-physician providers and their organizations. According the CMS, those providers subject to the fee assessment can pay it through www.pay.gov immediately after submitting the CMS-855 application or by paper check submitted along with the application or immediately thereafter. The Medicare Administrative Contractions reviewing the application will not be allowed to proceed without the fee having been paid or an exemption having been granted. The fee is nonrefundable except in the case where a hardship exception has been approved, the application is rejected prior to the beginning of the screening process or the application was denied as a result of the the imposition of a temporary moratorium by the CMS.
To qualify for a hardship exemption the provider must make a strong argument and provide all necessary supporting documentation. For an exemption based upon low profit/capital position, the provider must submit historical costs, recent financial reports or tax returns to substantiate it’s claim. Other positions that may suggest that a hardship exception is warranted include: Heavy bad debt expense, a significant level of financial assistance furnished to patients, being a significant member/partner of an organization that furnishes a disproportionate amount of medical care to low income populations, Whether an institutional provider receives considerable amounts of funding through disproportionate shared hospital payments, whether the provider is enrolling in a declared disaster area.
The CMS has 60 days to approve/disapprove a hardship exemption. If the request was turned down and the provider has not yet submitted the fee it has 30 days to do so. If the provider wishes to appeal the CMS decision, it may file a written request to reconsider with the CMS within 60 days of receipt of the initial decision notification.
The CMS considers the $505 fee to be well within the abilities of any well funded institutional provider enrolling in Medicare. The burden of proof is likely to be high and it will be the provider responsibility to make make it’s case, employing strong logic along with substantial supporting evidence. At the end of the day, unless it’s are real hardship for your organization, the best course of action is to go ahead and pay the fee thereby likely saving yourself an extra 60 days in the provider enrollment process. To learn complete details check here.