CMS Eases Healthcare Provider Enrollment Process in Response to COVID 19 Crisis

March 27, 2020

As the 2019 novel coronavirus (COVID-19) pandemic continues to strain the healthcare industry, the Centers for Medicare & Medicaid Services (CMS) eased healthcare provider enrollment rules. CMS has significantly streamlined the process for physicians and other providers seeking to temporarily enroll in Medicare. According to a CMS Frequently Asked Questions (FAQs) document released on March 23, 2020, physicians and non-physician practitioners can now call provider enrollment hotlines to quickly obtain temporary Medicare billing privileges during the COVID-19 public health emergency. CMS is also expediting new enrollment applications received on or after March 1, 2020, and waiving certain provider enrollment screening requirements.

Temporary Billing Privileges for Physicians and Non-Physician Practitioners

Physicians and non-physician practitioners (such as nurse practitioners, physician assistants, certified registered nurse anesthetists and clinical psychologists) can now call toll-free hotlines at their applicable Medicare Administrative Contactor (MAC) to request temporary Medicare billing privileges. To complete the telephonic enrollment process, physicians and non-physician practitioners will need to provide the following information: legal name, national provider identifier (NPI), Social Security number, a valid in-state or out-of-state license, address information and a telephone number.

The MAC will attempt to screen and enroll the physician or non-physician practitioner over the phone and will notify the physician or non-physician practitioner of its approval or rejection of temporary Medicare billing privileges during the phone conversation. Enrollment will be effective March 1, 2020, and services may be billed on or after this date. The MAC will follow up with an email to communicate the approval or rejection of the physician or non-physician practitioner’s temporary Medicare billing privileges. When the public health emergency declaration is lifted, physicians and non-physician practitioners who obtained temporary billing privileges will be asked to complete CMS-855 enrollment applications to establish full Medicare billing privileges, or have their temporary billing privileges deactivated.

Expedited Enrollment Applications

While other providers and suppliers — including suppliers of durable medical equipment, prosthetics, orthotics and supplies— cannot use the provider enrollment hotlines, CMS has directed MACs to expedite new enrollment applications received after March 1, 2020. Additionally, CMS commits to the MACs processing “clean” enrollment applications received on or after March 18, 2020, within seven business days (internet-based PECOS) or 14 business days (paper). CMS encourages providers to submit their applications via PECOS both for the speed and to assist the MAC’s enrollment review.

Waiver of Screening Requirements

To expedite the enrollment process during the COVID-19 public health emergency, CMS is waiving certain screening requirements, including application fees, criminal background checks, site visits and revalidations. CMS is also postponing accreditation and reaccreditation requirements and certain deadlines for durable medical equipment suppliers. CMS will resume these screening requirements when HHS lifts the public health emergency declaration.

CMS is offering this flexibility in its provider enrollment process under its authority under Section 1135 of the Social Security Act. Similar to other recent 1135 waivers it has issued, including blanket waivers aimed at expanding hospital capacity and expanding the availability of durable medical equipment and home health services and specific waivers regarding telehealth and quality reporting, it seeks to reduce burdens during the COVID-19 pandemic. In addition to a blanket waiver like the one described in this legal alert, providers also have the option to request 1135 waivers specific to their facilities and regulatory burdens, to reduce obstacles to providing needed care to their communities. Such an individual 1135 waiver request can be sent to the provider’s CMS regional office.

Please contact the authors of this alert with any questions and for additional guidance on how other COVID-19 considerations may impact healthcare providers. McGuireWoods has published additional thought leadership related to how companies across various industries can address crucial coronavirus-related business and legal issues, and the firm’s COVID-19 Response Team stands ready to help clients navigate urgent and evolving legal and business issues arising from the novel coronavirus pandemic.