Last Modified: 9/19/2018 Location: FL, PR, USVI Business: Part A, Part B
Q: What does Medicare consider to be “reportable event” (with regard to the provider/supplier’s enrollment record)? How long does a provider/supplier have to notify their Medicare administrative contractor (MAC) of the event?
A: Since providers and suppliers are responsible for maintaining and reporting changes to their enrollment information, a “reportable event” is one that requires an update to that record. The required timeframe for notifying the provider/supplier’s Medicare administrative contractor (MAC) of the change is based upon the type of “reportable event” that occurred
The following types of “reportable events” must be reported no later than 30 days after the event has occurred:
• Change in location/address -- occurs when a provider/supplier establishes, moves, or closes a practice or facility. It may also occur if the address is changed in any way.
• Change in final adverse action -- occurs when a physician is debarred or excluded by any federal or state health care program, has his/her medical license suspended or revoked by a state licensing authority, was convicted of a felony within the last 10 years, has his/her Medicare billing privileges revoked by a Medicare contractor, or has a revocation or suspension by an accreditation organization.
• Change in ownership -- occurs when there is a change in authorized officials or delegated officials for the organization.
The following types of “reportable events” must be reported no later than 90 days after the event has occurred:
• Change in business structure -- occurs when a provider or supplier changes the business structure of the practice (e.g., sole proprietorship to sole incorporated owner).
• Change in organization’s legal business name or tax identification number (TIN) -- occurs when the legal name of a practice or facility has changed and/or when its TIN has changed.
• Change in practice status -- occurs when a provider/supplier decides to voluntarily withdraw from the Medicare program for any reason (e.g., retirement).
Other types of “reportable events” include:
• Change in reassignment of benefits -- when a physician adds or voluntarily withdraws his or her reassignment of Medicare benefits through the CMS-855R form.
• Change in banking arrangements or payment information -- occurs when a provider or supplier changes his or her bank, bank account, or other payment application.
Note: This type of event should be reported immediately to the MAC by submitting a new electronic funds transfer (EFT) authorization agreement (i.e., CMS-588).
Providers and suppliers should utilize the internet-based Provider Enrollment, Chain, and Ownership System (PECOS) to update their Medicare enrollment record. Registered users may use the system for initial enrollment as well as to change, reactivate, or voluntarily terminate an existing enrollment record.
Access the Provider Enrollment Application Assistance Tool for more help in determining the appropriate enrollment form and documentation for submission. For more information about paper-based enrollment applications, please click here.
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