National Provider Enrollment: When and How You Change Information

Dave McGill
09-05-2023
Blog

Whether you're an O&P, a DME, or a physician practice providing items to your own patients under the Stark Law's ancillary services exception, you have to comply with Medicare's Supplier Standards. Supplier Standard #2 requires you to notify your region's National Provider Enrollment Contractor - Novitas for the East Region and Palmetto for the West -  of any changes to the information you provided when applying for Medicare billing privileges using the CMS 855s form. 

What You Need to Know:

There are multiple scenarios triggering your obligation to update/change the information on your CMS 855s. All the changes listed below require notice to your NPE contractor within 30 days of the change:

  1. A change in the products or services you provide. Be aware that some of these changes also require you to obtain appropriate state licenses that you need to submit to support those CMS 855s edits. 
  2. A change of address.
  3. A change in ownership. This applies both to organizational ownership and individual ownership changes.
  4. Voluntary termination of your organization. This applies when you are closing your business or withdrawing from the Medicare program.
  5. Change of legal business name. You must include an official document from the IRS verifying this information.

What This Means for You:

Complying with these change requirements - especially in a timely fashion - is critical to prevent Medicare from suspending your billing privileges. Taking an "I'll get to it when I get to it" approach to notifying your NPE contractor can place your entire Medicare revenue stream at risk. We are aware of instances where a Medicare contractor became aware of one or more of the above-listed changes not through a CMS form 855s request change, but through the business activity of the billing entity. And in those instances, Medicare billing privileges are immediately suspended and can take significant time to reactivate. (They can also result in further inquiries and investigations that place your business at risk.)

Therefore, make sure you understand the situations triggering an obligation to notify your NPE contractor within 30 days. Calendar the deadlines for submissions prominently and monitor them closely once sent. For more information about this topic, check out Novitas's Change of Information Guide if you're in the East Region and Palmetto's Change of Information Guide if you're in the West.