New EFT form, prospect of fines for out-of-date enrollment information loom

Why This Topic Matters

Practices that bill Medicare need to stay current with enrollment procedures and record maintenance. Understanding CMS form changes and the compliance environment can help organizations prepare for administrative updates and avoid risk tied to outdated enrollment data.

Article Sections

1. Enrollment

   Overview of upcoming Medicare enrollment-related form changes and general EFT enrollment updates. The section also introduces broader administrative considerations for provider enrollment records.

2. Change of ownership: A practice does not necessarily undergo a change in ownership when it acquires another corporation or transfers corporate stock into an established entity. Change of ownership does occur when a partner is removed from an established ownership structure, unless the partners expressly agree otherwise.

   Discussion of ownership-related enrollment issues and how changes in practice structure may affect Medicare enrollment records. The section focuses on general administrative distinctions raised in the article.

3. State-specific licensure and other requirements: You can’t meet Medicare’s requirements for billing unless you also meet state-specific licensure and other requirements related to billing.

   General reminder that Medicare enrollment and billing compliance may depend on meeting applicable state-level licensing and related requirements. The section addresses broader eligibility and administrative compliance topics.

4. Authorized versus delegated: An authorized official is an appointed official, such as a CEO, CFO, general partner, chairman of the board or direct owner with legal authority to enroll in Medicare or to make changes or updates to your practice’s status in the Medicare program. The authorized official may delegate the authority to report changes to an enrollment record to a delegated official. That person is required to have an ownership or control interest in the practice or be a W-2 managing employee of the practice.

   Explanation of enrollment roles and the relationship between authorized and delegated officials in Medicare administrative processes. The section covers who may act on behalf of a practice in enrollment-related matters.

5. Threat of fines for non-timely updates

   Discussion of CMS scrutiny of outdated enrollment information and the prospect of penalties tied to incorrect enrollment records. The section addresses compliance risk and the importance of keeping records current.