Untangling Medicare’s New Stay of Enrollment Status & Its Impact

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Untangling Medicare’s New Stay of Enrollment Status & Its Impact

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Stay of enrollment

Practices are accustomed to enrollment and credentialing errors when it comes to Medicare, and these errors often lead to penalties, including lost pay. One way CMS is attempting to rectify this issue is with the recent debut of a new enrollment status called a “stay of enrollment.”

Check out a few facts you must know to prepare for the updated stay of enrollment status.

CMS Aims to Take it Easy if You Make Simple Mistakes

As many practices are aware, you currently face two main sanctions from CMS if you aren’t in compliance with Medicare enrollment guidelines:

  • The provider’s enrollment may be revoked, meaning that provider cannot reenroll in the Medicare program for a defined period of up to 10 years.
  • The provider’s enrollment may be deactivated, meaning that the provider is removed from the Medicare program and has to reapply to be admitted again, with no retroactive billing for services performed during the deactivation period.

Under a new CMS update issued on March 1, however, the new enrollment stay status may apply if you make a minor error during the enrollment process. It simply pauses your enrollment, allowing you to rectify any issues before reactivating your enrollment. This means you won’t have to reapply for enrollment from the beginning.

During the stay, the provider technically remains enrolled in Medicare, but the MAC will reject claims for dates of service that fall within the stay period. The stay won’t last longer than 60 days, and it ends on the date you comply with Medicare enrollment requirements. After the enrollment stay is lifted, your practice can resubmit claims for services provided during the stay period.

Here’s When Stay of Enrollment Applies

CMS will implement an enrollment stay by using the following two criteria:

  • The provider is noncompliant with at least one Medicare enrollment requirement
  • The provider can fix the noncompliance issue by submitting a CMS-855, CMS-20134 or CMS-588 form.

If the issue at hand cannot be rectified by submitting one of the three forms noted above, a stay will not be an option.

Examples of When an Enrollment Stay May Apply

CMS provides several examples of what might qualify a practice for a stay. For instance:

  • The provider fails to respond to a revalidation request by the deadline
  • The provider doesn’t report an address change in a timely manner
  • A supplier doesn’t report the deletion of a managing employee

In cases when CMS believes your practice should fall under an enrollment stay and you disagree, you are permitted to file a rebuttal noting that you met the enrollment requirements and the stay was erroneously applied.

Seeking more information on Medicare enrollment and credentialing? Get the information you need from expert Yesenia Servin, CPMSM, PESC, during her online training event, Medicare PECOS 2.0: Prepare Your Practice Now for Launch. Register today!


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