Frequently Asked Questions (FAQs) – Summary
How is CMS using its authority under Section 1135 of the Social Security Act to offer flexibilities with Medicare provider enrollment to support the Novel Coronavirus (COVID-19) national emergency?
CMS is exercising its 1135 waiver authority in the following ways:
Physicians and Non-Physician Practitioners Eligible to Enroll in Medicare
- Establish toll-free hotlines to enroll and receive temporary Medicare billing privileges
- Waive the following screening requirements:
o Criminal background checks associated with fingerprint-based criminal background checks (FCBC) – 42 C.F.R 424.518 (to the extent applicable)
o Site visits – 42 C.F.R 424.517
- Postpone all revalidation actions
All Other Providers and Suppliers (including DMEPOS) Eligible to Enroll in Medicare
- Expedite any pending or new applications
o All clean web applications will be processed within 7 business days and all clean paper applications in 14 business days
- Waive the following screening requirements for all enrollment applications received on or after March 1, 2020:
o Application Fee – 42 C.F.R. 424.514
o Criminal background checks associated with fingerprint-based criminal background checks (FCBC) – 42 C.F.R. 424.518 (to the extent applicable)
o Site-visits – 42 C.F.R. 424.517
- Postpone all revalidation actions
CMS is waiving the following screening requirements for all enrollment applications received on or after March 1, 2020:
- Application Fee – 42 C.F.R. 424.514
- Criminal background checks associated with the FCBC – 42 C.F.R. 424.518 (to the extent applicable)
- Site-visits – 42 C.F.R. 424.517 CMS is also postponing all revalidation actions.
Will my temporary Medicare billing privileges as a physician or non-physician practitioner be deactivated once the national emergency is lifted?
Your Medicare billing privileges are being granted on a provisional basis as a result of the public health emergency declaration and are temporary. Upon the lifting of the public health emergency declaration, you will be asked to submit a complete CMS-855 enrollment application in order to establish full Medicare billing privileges, following the MAC’s review of your application.
Failure to respond to the MAC’s request within 30 days of the notification, will result in the deactivation of your temporary billing privileges.
No payments can be received for services provided after the deactivation of your temporary billing privileges.
Can Medicare fee-for-service rules regarding physician State licensure be waived in an emergency?
The HHS Secretary has authorized 1135 waivers that allow CMS to waive the Medicare requirement that a physician or non-physician practitioner must be licensed in the State in which s/he is practicing for individuals for whom the following four conditions are met: 1) the physician or nonphysician practitioner must be enrolled as such in the Medicare program, 2) the physician or nonphysician practitioner must possess a valid license to practice in the State which relates to his or her Medicare enrollment, 3) the physician or non-physician practitioner is furnishing services – whether in person or via telehealth – in a State in which the emergency is occurring in order to contribute to relief efforts in his or her professional capacity, and 4) the physician or non-physician practitioner is not affirmatively excluded from practice in the State or any other State that is part of the 1135 emergency area. In addition to the statutory limitations that apply to 1135-based licensure waivers, an 1135 waiver, when granted by CMS, does not have the effect of waiving State or local licensure requirements or any requirement specified by the State or a local government as a condition for waiving its licensure requirements. Those requirements would continue to apply unless waived by the State. Therefore, in order for the physician or non-physician practitioner to avail him- or herself of the 1135 waiver under the conditions described above, the State also would have to waive its licensure requirements, either individually or categorically, for the type of practice for which the physician or non-physician practitioner is licensed in his or her home State. A physician or non-physician practitioner may seek an 1135-based licensure waiver from CMS by contacting the Medicare Provider Enrollment Hotline for the MAC that services their geographic area.
Can the distant site practitioner furnish Medicare telehealth services from their home?
Or do they have to be in a medical facility?
There are no payment restrictions on distant site practitioners furnishing Medicare telehealth services from their homes. The practitioner is not required to update their Medicare enrollment with the home location. The practitioner should list the home address on the claim to identify where the services were rendered. The discrepancy between the practice location in the Medicare enrollment (clinic/group practice) and the practice location identified on the claim (provider’s home location) will not be an issue for claims payment.
I am due to re-validate. Will my due date be extended?
CMS is temporarily ceasing revalidation efforts for all Medicare providers or suppliers. Upon the lifting of the public health emergency, CMS will resume revalidation activities
Full Reference: https://www.cms.gov/files/document/provider-enrollment-relief-faqs-covid-19.pdf