Home Health & Hospice Week

Validate your enrollment information and compliance program provisions to stay ahead of the game.

If you’ve been putting off looking at the 2024 physician fee schedule final rule while you deal with provisions from the home health rule, it’s time to quit procrastinating.

Why? The final rule the Centers for Medicare & Medicaid Services released on Nov. 2 updates certain Medicare and Medicaid provider and supplier enrollment regulations for all provider types — including home health and hospice agencies.

For 2024, there is a $709 application fee for institutional providers that are initially enrolling in the Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP); revalidation of Medicare, Medicaid, or CHIP enrollment; or addition of a new Medicare practice location. This fee is required with any enrollment application submitted in 2024.

Heed These Enrollment Changes

Several new PFS regulatory provisions address provider enrollment, including:

1. Stay of Enrollment. This is a new Medicare provider enrollment action/status that is a “preliminary, interim status — prior to any subsequent deactivation or revocation — that would represent, in a sense, a ‘pause’ in enrollment, during which the provider or supplier would remain enrolled in Medicare” but would not receive payment for items or services furnished during this period, according to the rule.

For CMS to impose a stay, the provider must be non-compliant with at least one enrollment requirement in Title 42. Providers can remedy the non-compliance via the submission of an appropriate enrollment report (i.e., Form CMS-855A).

CMS will notify the affected party in writing of the stay. The stay period will last no longer than 60 days from the postmark date of the notification letter. CMS believes the documents necessary to remove the stay are less of a burden for the provider to produce and deliver to the Medicare contractor who in turn can process the documents more quickly.

Watch out: The authority to impose a stay is at CMS’ discretion. It gives no specific examples of non-compliance, but it clarifies a stay is intended to reduce the severity of CMS action for minor cases of non-compliance that would ordinarily have triggered a deactivation.

Be aware: There is a rebuttal opportunity within 15 days from the date of the written notice. The process is similar to the deactivations and payment suspensions rebuttal process.

The claims system will reject claims submitted with dates of service within the stay period, but retroactive payment is permissible (assuming all other requirements for payment of the claim are met) if the provider becomes compliant within the stay period.

2. Reporting changes in practice location. CMS requires all Medicare provider and supplier types to report all additions, deletions, or changes in their practice locations within 30 days.

3. New and revised Medicare denial and revocation authorities. This allows CMS to revoke an existing enrollment or deny a new application (see details in box, p. 333).

4. New and clarified definitions. These help explain certain provider enrollment concept changes made to Indirect Ownership and Indirect Ownership Interest; Physical therapists (PTs) and Occupational therapists (OTs) in Private Practice and Speech-Language Pathologists; and clarification of the term “organization” under the Authorized or Delegated Officials definition to mean the enrolling entity as identified by its legal business name (LBN) or tax identification number (TIN) and not the provider type(s) that the entity is enrolling under.

Attention: Revision of the pattern or practice definition was not finalized, but CMS states it may reconsider this issue in future rulemaking.

5. Timeframe in Medicaid termination database. The length of time for which a Medicaid provider will remain in the Medicaid termination database was clarified as 10 years. However, CMS adds that nothing would prohibit an initially terminating state from imposing a termination period of greater than 10 years consistent with that state’s laws.