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. 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 through 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. There is a published document but it was a little difficult to wade through all 110 pages.

I'm usually a "glass is half full" person and as I read back through 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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