Use Medicare billing number or lose it, CMS warns

The agency is making refinements to the provider enrollment process.

By Markian Hawryluk, AMNews staff. Sept. 2, 2002.

Washington -- Medicare is trying to clean out its Rolodex.

In a recent transmittal, the Centers for Medicare & Medicaid Services has instructed Medicare carriers to deactivate billing numbers for physicians and other health care professionals who do not bill the Medicare program for four consecutive quarters.

Contractors are now required to track quarterly the provider identification numbers for which no claims have been submitted. They must notify practitioners who appear on the list for four consecutive quarters that the number can no longer be used to bill the program.

The measure is intended to prevent fraudulent billing using the Medicare numbers of physicians who are no longer practicing or no longer participating in the program, CMS said in the transmittal.

The communication to carriers also stipulated that practitioners must notify carriers of any changes to information on their Medicare enrollment forms within 30 days of the change. Failure to do so could result in deactivation of a provider billing number.

The transmittal does not indicate whether the rules apply to physicians who were not required to complete the form. Only physicians who enrolled in the Medicare program after 1996 have had to submit the enrollment form to get a provider identification number.

The changes were included in a program transmittal implementing a host of minor refinements to an enrollment process that has garnered much criticism from physicians.

Physicians complained that the forms to enroll in the Medicare program were time-consuming and served little purpose. In many regions, physicians had to wait months to receive enrollment approval and the provider number to bill the program. [...]