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Medicare Compliance & Reimbursement

ENROLLMENT:

Why Carriers Are Holding Tens Of Thousands Of Applications In Backlog

Published on Wed Nov 28, 2007

Revalidate your enrollment information now, to avoid hold-ups later.

A new clog in the Medicare physician enrollment process is holding up applications in Florida and Texas, but also in other areas, says consultant Leslie Witkin with Physicians First Physician Consulting in Orlando, FL.

Problems started in February 2006, when the Centers for Medicare & Medicaid Services (CMS) sent carriers a memo saying that they should send back any applications that were missing information, instead of contacting the provider as in the past. Also, carriers would accept new enrollment applications only 15 days before the physician's start date, not 60 days before as in the past.

In April, CMS came out with a new enrollment regulation, which required providers to revalidate their Medicare enrollment information every five years. As of June, if your physician group had never enrolled as a group and you enrolled a new physician, the carrier would ask your group to revalidate, Witkin says.

CMS introduced new enrollment forms in May, with no grace period, Witkin adds. If one of the new form's confusing checkboxes threw you off, or you formatted your address slightly differently in the occupational and correspondence addresses, then the carrier would send the application back.

Finally, in November 2006, CMS said that if you hadn't changed your enrollment information since its new system started in November 2003 and you submit a change now, you'll need to revalidate all your information right away.

As of Oct. 5, 2006, carrier First Coast Service Options had 7,000 outstanding applications, Witkin told the December 12 physician Open Door Forum (ODF). By November, that number had risen to 12,200 and by Dec. 5, the carrier was sitting on 13,000 applications. The carrier warned providers not to call until at least 60 days after sending in an enrollment application, Witkin added. The carrier is supposed to pre-screen applications within 15 days, she noted.

CMS officials said they didn't have enough hard data on the problem, such as how long it was taking to process a "clean" application and how many "clean" applications had been held up.

An official with the American Medical Association said she'd gotten a number of phone calls recently about "widespread" problems with enrollment. She promised to provide CMS with data on the problem.

What to do: If you have problems, contact your CMS regional office or CMS' Physicians Regulatory Issues Team (www.cms.hhs.gov/PRIT). If you haven't updated your enrollment information since 2003, revalidate it now, Witkin urges.

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