One-Time Mailing of Supplier Responsibilities Letter: Individual Practitioners Only
MLN Matters® Number: MM6278 Revised
Related Change Request (CR) #: 6278
Related CR Release Date: January 29, 2010
Effective Date: November 2, 2009
Related CR Transmittal #: R626OTN
Implementation Date: November 2, 2009
Note: This article was revised on February 23, 2010, to reflect changes made to CR 6278 on January 29, 2010. The article was revised to include the three scenarios on pages 2 and 3. The CR release date, transmittal number, and the Web address for accessing CR 6278 were also revised. All other information remains the same.
Provider Types Affected
All physicians and non-physician practitioners with Medicare billing privileges are affected.
Provider Action Needed: STOP – Impact to You
All physicians and non-physician practitioners must comply with Medicare reporting responsibilities and report relevant address and other enrollment changes in a timely manner. For example, failure to report an address change timely may affect your billing privileges and payment of claims.
CAUTION – What You Need to Know
The Centers for Medicare & Medicaid Services (CMS) has directed Medicare contractors (carriers and Medicare Administrative Contractors (MACs)) to notify all sole proprietor physicians and non-physician practitioners of their reporting responsibilities with a one-time mailing. Contractors must complete this mailing to physicians, who are sole proprietors, by November 30, 2009, and to sole proprietor non-physician practitioners by December 31, 2009.
GO – What You Need to Do
You need to review the mailing and ensure that you have complied with the reporting responsibilities. Make sure your billing staffs are aware of these responsibilities.
Background
Contractors must notify all active physicians and non-physician practitioners of their reporting responsibilities with a one-time mailing using the CMS developed materials cited above. Contractors must complete this mailing to sole proprietor physicians by November 30, 2009, and to sole proprietor non-physician practitioners by December 31, 2009.
Medicare contractors will deactivate the billing privileges for the practice locations associated with any Provider Transaction Access Number (PTAN) of any letter returned by the post office as undeliverable and the contractor does not already have a change of address enrollment application pending based on the following three scenarios:
- Scenario 1: If the provider has one PTAN and multiple practice locations, contractors will deactivate the practice location of the returned letter and mail a revalidation letter to the special payment or correspondence address of the provider/supplier. If the provider/supplier does not respond to the revalidation letter, the Medicare contractor will revoke all practice locations.
- Scenario 2: If a provider/supplier has two or more PTANs and multiple practice locations, the contractor will deactivate the practice location of the returned letter(s) and mail a revalidation letter to the provider’s special payment or correspondence address. If the provider does not respond for all PTANs, the contractor will revoke all practice locations. If the provider responds for only one of the PTANs, the contractor will deactivate the practice locations of the PTANs for which there was no response.
- Scenario 3: If a letter is returned for a provider whose only practice location is a hospital or skilled nursing facility, the contractor will not deactivate that providers’ PTAN, but will mail a follow-up letter and revalidation request to the provider’s correspondence address.
The follow-up revalidation letter will explain the need to report current address information via a CMS-855 form.
Billing privileges will remain deactivated until the CMS-855 is received and processed. Claims for services rendered from the date of deactivation until the date of reactivation may not be payable per 42 Code of Federal Regulations (CFR) 424.516(d)(1)(iii) and 42 CFR 424.540(a)(2). Contractors will follow the procedures in the Program Integrity Manual Chapter 10 Section 13 to reactivate Medicare billing privileges.
Additional Information
Following are the titles and brief descriptions of the fact sheets cited in the background above which may be downloaded from the CMS website:
Fee-For-Service Provider Enrollment Reporting Responsibilities for Individual Physicians Enrolled in the Medicare Program
After enrolling in the Medicare Program, all physicians are responsible for maintaining and reporting changes in their Medicare enrollment information to their designated Medicare contractor. This fact sheet outlines such reportable events for physicians. (March 2009) (ICN# 901643)
Fee-For-Service Provider Enrollment Reporting Responsibilities for Individual Non-Physician Practitioners Enrolled in the Medicare Program
After enrolling in the Medicare Program, all non-physician practitioners are responsible for maintaining and reporting changes in their Medicare enrollment information to their designated Medicare contractor. This fact sheet outlines such reportable events for individual non-physician practitioners. (March 2009) (ICN# 901644)
If you have questions, please contact the Palmetto GBA Provider Contact Center at their toll-free number (866) 332-7025 (Ohio and West Virginia) or (888) 828-2092 (South Carolina Part B).
Disclaimer:
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.