Provider Reactivation Changes Effective March 18, 2015

Change Request 8901, implemented on March 18, 2015, incorporated several provider enrollment policies into Chapter 15 of the Medicare Program Integrity Manual.  One of the changes is associated with the reactivation of Medicare billing privileges.  In summary, when the Medicare Administrative Contractor (MAC) approves a Part B non-certified provider’s/supplier’s reactivation request, the effective date of the reactivation is now the date the MAC received the reactivation request (i.e., the reactivation application or the Reactivation Certification Package[RCP]).  The effective date referenced is the effective date of Medicare billing privileges.  Additionally, the Part B non-certified provider/supplier will be issued a new Provider Transaction Access Number (PTAN) in conjunction with the reactivation.

Note:  A Part B non-certified provider/supplier is a provider/supplier type other than an Ambulatory Surgical Center (ASC) or a Portable X-ray supplier.

Medicare Program; Contract Year 2015 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs.

• If a MAC approves a provider’s or supplier’s Form CMS-855 reactivation application or Reactivation Certification Package (RCP) for a Part B non-certified supplier, the reactivation effective date will be the date the MAC received the application or RCP that was processed to completion. Also, upon reactivating billing privileges for a Part B non-certified supplier, the MAC will issue a new Provider Transaction Access Number (PTAN).

• CMS may deny a physician’s or eligible professional’s Form CMS-855 enrollment
application under § 424.530(a)(11) if:
• The physician’s or eligible professional’s Drug Enforcement Administration (DEA) Certificate of Registration to dispense a controlled substance is currently suspended or revoked; or
• The applicable licensing or administrative body for any state in which the physician or eligible professional practices has suspended or revoked the physician’s or eligible professional’s ability to prescribe drugs, and such suspension or revocation is in effect on the date the physician or eligible professional submits his or her enrollment application to the Medicare contractor.
• CMS may revoke a physician’s or eligible professional’s Medicare enrollment under § 424.535(a)(13) if:
• The physician’s or eligible professional’s DEA Certificate of Registration is suspended or revoked; or
• The applicable licensing or administrative body for any state in which the physician or eligible professional practices has suspended or revoked the physician’s or eligible professional’s ability to prescribe drugs.
• CMS may revoke a physician’s or eligible professional’s Medicare enrollment under § 424.535(a)(14) if CMS determines that the physician or eligible professional has a pattern or practice of prescribing Part D drugs that falls into one of the following categories:
• The pattern or practice is abusive or represents a threat to the health and safety of Medicare beneficiaries or both.