Use Medicare billing number or lose it, CMS warns

The agency is making refinements to the provider enrollment process.

By Markian Hawryluk, amednews 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.

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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.

Medicare billing numbers not used in four consecutive quarters are to be deactivated.

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.

Jaded history

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.

Yet during that time, the physician cannot submit claims to receive Medicare payments for services provided to patients. That created substantial hardship for physicians trying to establish their practices in a community.

Physicians just out of their residency training often had to spend several months assembling their documentation for state licensure and hospital privileges only to wait even longer to be enrolled in the Medicare program. And if any information was missing, carriers often returned the entire application and required resubmission.

90% of Medicare provider enrollment forms must be processed in 60 days.

Working with physician groups, CMS has made a number of changes in the past year to streamline the provider enrollment process. The agency issued new enrollment forms in November 2001 that allow physicians to complete only those portions of the form relevant to their practices. The agency also tightened its requirement for carrier processing of the enrollment forms, requiring 90% of applications to be processed within 60 days and 99% within 120 days.

But physicians say the process still needs improvement.

The American Medical Association has urged CMS to issue temporary provider numbers that would allow physicians to see Medicare patients while their enrollment forms are being processed. Providing a limited amount of temporary numbers would help facilitate a smooth transition for patients and physicians during the enrollment process, the AMA said in recent congressional testimony.

Additionally, the group has called for forms that can be filled out on a Web site with relevant attachments forwarded to the carriers as needed.

The AMA has also opposed CMS suggestions to have physicians revalidate information on the enrollment forms every three years. Even with the streamlined forms, that could pose substantial paperwork for physician practices and additional work for the carriers processing these forms.