Last Modified: 11/5/2018 Location: FL, PR, USVI Business: Part A, Part B
Q: When is the application fee required for processing provider enrollment applications?
A: With the exception of physicians, non-physician practitioners, physician group practices and non-physician practices, providers and suppliers that are (1) initially enrolling in Medicare, (2) adding a practice location, or (3) revalidating their enrollment information, must submit with their application:
• An application fee in an amount prescribed by CMS, and/or
• A request for a hardship exception to the application fee
Note: The fee for January 1, 2018, through December 31, 2018, is $569.00
This requirement applies to applications that First Coast Service Options (First Coast) receives on or after March 25, 2011. Note that a physician, non-physician practitioner, physician group, or non-physician practitioner group that is enrolling as a DMEPOS supplier via the CMS-855S application must pay the required application fee.
Note: Do not mail application fee payments. Payments cannot be accepted by mail or phone.
For providers that continue to use the CMS-855 paper enrollment applications, access https://pecos.cms.hhs.gov/pecos/feePaymentWelcome.do to pay the application fee. For those who submit applications online via internet-based Provider Enrollment, Chain, and Ownership System (PECOS), as you proceed through the application process, if a fee is required, you will be prompted to submit your payment.
The application fee is non-refundable, except if it was submitted with one of the following:
• A hardship exception request that is subsequently approved
• An application that was rejected prior to the Medicare contractor’s initiation of the screening process
• An application that is subsequently denied as a result of the imposition of a temporary moratorium as described in 42 CFR 424.570
Even though the Centers for Medicare & Medicaid Services (CMS) will send on a regular basis to First Coast a listing of providers and suppliers that have paid the application fee, it is still encouraged that provider/suppliers send with their application a copy of the receipt that is received after making the payment.
To find out if your provider/supplier is required to pay the application fee, access the Application Fee Matrix .
Sources: internet-only manual (IOM) 100-08, Chapter 15, Section 15.19 ; MLN MattersŪ Special Edition SE1130 ; CMS’ Medicare application fee web page
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