decisionhealth Newsletters, Part B News - 2013 Issue 5 (May)
Don’t let physician’s licensure history sidetrack enrollment
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Article Overview
This article explains how a physician’s prior or inactive licensure in another state can affect Medicare enrollment when the provider moves to a new practice location. It is aimed at physician practices, billing/enrollment staff, and compliance professionals who manage Medicare enrollment, state licensure, and MAC communications. The discussion focuses on enrollment coordination, revocation risk, voluntary termination, timing, and the role of CMS and Medicare administrative contractors in resolving problems.
Why This Topic Matters
Enrollment and licensure mismatches can create significant Medicare billing disruptions for providers and practices. Understanding the administrative process helps organizations avoid unintended revocations and respond quickly if a revocation is initiated.
Article Sections
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Enrollment
Overview of a provider moving between states and how prior licensure and enrollment status can create downstream Medicare enrollment issues. The section also discusses communication among practices, state licensing bodies, CMS, and Medicare administrative contractors.
What You Will Learn
- How prior state licensure history can affect Medicare enrollment when a provider relocates
- Why enrollment and license status should be reviewed when a physician joins a new practice
- How Medicare administrative contractors and CMS are involved when enrollment problems arise
- What general steps are discussed for responding to an enrollment revocation or separation issue
Who Should Read This
- Physician practices
- Billing and enrollment staff
- Compliance officers
- Practice administrators
- Healthcare consultants
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