Definition of Provider and Supplier

05 - Definition of Provider and Supplier (Rev. 12423; Issued: 12-20-23; Effective: 01-01-24; Implementation: 01-02-24) This chapter uses the definition of provider and supplier found in 42 CFR 400.202. These are: Provider means a hospital, a CAH, a skilled nursing facility, a comprehensive outpatient rehabilitation facility, a home health agency, or a hospice that has in effect an agreement to participate in Medicare, or a clinic, a rehabilitation agency, or a public health agency that has in effect a similar agreement but only to furnish outpatient physical therapy or speech-language pathology services, or a community mental health center that has in effect a similar agreement but only to furnish partial hospitalization or intensive outpatient services. Supplier means a physician or other practitioner, or an entity other than a provider that furnishes health care services under Medicare. Note that while rural health clinics, Federally qualified health centers, and renal dialysis facilities are suppliers under the regulation, they submit most claims to A/B MACs (A).