Don't Ignore CMS Reporting Requirements for Payor Enrollment Changes

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If your practice or healthcare facility undergoes an organization change or change in office location, you must report the changes quickly to the Centers for Medicare & Medicaid Services (CMS) or face significant penalties.

CMS must be notified of a variety of transactions that qualify as either a change in ownership or a change of information:

  • A change in ownership (CHOW) can be a merger of one provider into another, a change in the members of a partnership, or a consolidation of 2 or more organizations into a new one.

  • A change in information (CHOI) is other information changes about the practice, such as moving to a new location, closing a location or a stock transfer.

 

If any of these types of changes occur to your business, you must notify CMS properly to meet the requirements in the Medicare provider agreement.

The Clock Is Ticking: Act Quickly To Report Changes Within the Deadlines

To avoid potentially significant penalties, you must report CHOW or CHOI changes promptly:

  • For physicians, physician organizations, non-physicians and non-physician organizations, report any change in ownership or practice location including payment address or adverse legal action to CMS within 30 days. You have 90 days to report all other changes to Medicare enrollment information such as changes to taxpayer identification number, billing agency and officer changes in a corporation.

  • For hospitals and most other suppliers, report change in ownership, change in authorized or delegated officials or change in managerial control to CMS within 30 days. You have 90 days to report all other changes including taxpayer identification number, adverse legal actions, officer changes in a corporation, payment address and billing agency.

All changes should be reported via the Provider Enrollment, Chain and Ownership System (PECOS).

Note that providers have been penalized for failure to notify CMS of changes, with punishments ranging from fines to enrollment suspension and even a period of termination from the Medicare program.

Read more about timely reporting of provider enrollment information changes in this MLN Matters® newsletter.

Let Us Manage All Your Payor Enrollment Services

If you require medical credentialing and payer enrollment needs for your practice or medical facility, please contact 1st Assistant. Our experienced and dedicated specialists will provide all credentialing and enrollment services quickly and will monitor your account for ongoing updates and re-attestations. Heidi Henderson, our company owner and President, is eager to meet you and discuss your payer enrollment needs. Please call us at 512.201.2668 or contact us via the website.