Stay of Enrollment

What You Need to Know

On March 1, 2024, CMS released a Change Request (CR 13449) that included information about changes to Chapter 10 of the Medicare Program Integrity Manual, including a new provider enrollment status called a "stay of enrollment." Effective April 1, 2024, this change affects all providers billing Medicare Administrative Contractors (MACs) for services provided to Medicare patients, including physicians and suppliers. A stay of enrollment, or "stay," is a preliminary, interim status representing a pause in enrollment. This enrollment status may be activated by CMS if you meet the following two criteria:

1. You are not compliant with at least one Medicare enrollment requirement, and
2. You can become compliant by submitting an applicable CMS form (ACF) such as CMS-855, CMS-20134, or CMS-588.

The length of the stay is defined in a Stay Notification Letter sent by the MAC and cannot be more than 60 days. The letter will also specify which ACF must be submitted in order to resume compliance. The stay ends when either (1) the provider submits the appropriate ACF or (2) the day after the stay period ends, whichever comes first. The provider remains enrolled with Medicare during the stay, but any claims submitted with a date of service within the stay period will be rejected. Once the stay is over, these claims will be eligible for payment if the provider resumes compliance with Medicare enrollment requirements, as determined by CMS or the MAC. If a provider believes they met all applicable enrollment requirements and that the stay should not have been imposed, they have the right to submit a rebuttal. 

What this Means for You

CMS introduced a stay of enrollment option in hopes that it will decrease the burden on providers whose non-compliance is easily fixed. Historically, billing privileges were either deactivated or revoked for all instances of non-compliance with Medicare standards. A stay of enrollment is not only faster to rectify, but claims for services provided during a stay can be submitted and paid after the stay is lifted. This new enrollment status will allow you to correct minor instances of non-compliance without permanently taking away your billing privileges for an extended period of time.

You may receive a Stay Notification Letter from your DME MAC if you fail to adhere to a reporting, revalidation, or supplier standard requirement that is easily corrected by submitting an ACF. For example, if you forget to notify your NPE contractor of a change in address or change in ownership within 30 days, you are out of compliance with the Medicare Supplier Standards. Because these instances of non-compliance can be addressed by submitting an updated CMS-855S form, you would likely be placed on a stay of enrollment. Your stay period begins on the postmark date of the notification letter, and the length of the stay will vary, up to a maximum of 60 days, depending on the reason for non-compliance (all assigned stays for revalidation non-responses are 30 days).

It is important to respond to these requests as quickly as possible. This will not only ensure you do not miss the deadline but will also reduce the length of your stay and minimize delays in payment. The Medicare Program Integrity Manual states "the contractor need not have begun processing the ACF for a stay to be lifted. Even if the application is later returned, rejected, or denied, the stay ceases on the date the application is submitted." Therefore, as soon as the contractor receives your updated ACF, the stay of enrollment ends and you can once again submit claims with a date of service that falls within the stay period. However, if the contractor determines that you are still out of compliance after reviewing your ACF, or if you submit the requested form after your stay period expires, your enrollment may be retroactively deactivated.

You also have the option to submit a rebuttal instead of sending the requested ACF if you believe that the stay should not have been imposed. Stay rebuttals for DMEPOS suppliers are handled by the Provider Enrollment Operations Group (PEOG) appeals and rebuttals contractor. You can only submit one rebuttal per stay, and it must be received within 15 days of the postmark date on the notification letter. Your rebuttal letter should thoroughly explain why you disagree with their justification for a stay, and you should include any supporting documents that show you've met all applicable enrollment requirements. Your Stay Notification Letter will have further instruction on how to properly submit a rebuttal.

For more information, you can review the CMS Stay of Enrollment MLN Fact Sheet.