Payment Matters: Medicare Enrollment Application Fees

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CMS is issuing guidance to implement the March 25, 2011 Medicare and Medicaid enrollment regulation changes that were highlighted in a prior Payment Matters article, “Increased Scrutiny to Obtain and Maintain Medicare and Medicaid Enrollment – Final Regulations Published.” Specific guidance for paying the Medicare enrollment application fee was including in Transmittal 371, which updates Chapter 15 of the Medicare Program Integrity Manual, and the associatedMLN Matters article.

An enrollment application fee must be paid by any “Institutional Provider,” which is defined to include all providers and suppliers except for physicians and nonphysician practitioners enrolling as an individual or group. The application fee is required when (1) initially enrolling in Medicare, (2) adding a practice location, or (3) submitting a required revalidation application. The fee is updated annually, with an initial fee of $505.00 for the partial year from March 25 through December 31, 2011. Payment must be made electronically through the Pay.gov website via a credit card, debit card, or check. CMS will regularly send a list of providers and suppliers (i.e., the “Fee Submitter List”) that have paid an application fee to the respective enrollment contractors.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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