The Patient Protection and Affordable Care Act includes some changes to the provider enrollment process for Medicare. The objective of these changes is to decrease the amount of fraud and abuse in the program. The changes include the following:

• Once every 5 years providers must re-certify the accuracy of their enrollment information

• If a provider receives a inquiry form a Medicare contractor he/she has 60 calendar days to respond. If a provider doesn’t respond in the allotted time payments may be suspended.

• A medicare contractor can perform additional re validations at any time.

• When a current owner sells over 5% of his or her ownership in a provider group the changes must be reported withing 30 days.

• When a group changes locations, opens a new office or closes one, notification is required

• Any Final Adverse Action takes place

• Change in Legal Business Name or TIN needs to be reported

• When an authorized or delegated official is added or removed.

• A change in its bank or bank account

It’s important that you take the time to insure that these changes to your provider enrollment record are complete and accurate. It’s a good idea to appoint someone to specifically handle these issues either within the organization or delegated to an outside group well acquainted with the requirements