Enrolling to Receive Medicare Payment

10.1.2 – Enrolling to Receive Medicare Payment (Rev. 10672; Issued: 03-18-21; Effective: 03-12-21; Implementation: 03-22-21) No provider or supplier shall receive payment for services furnished to a Medicare beneficiary unless the provider or supplier is enrolled in the Medicare program. Further, it is essential that each provider and supplier enroll with the appropriate Medicare Administrative Contractor. We use the term “enrollment” generally to include activities a provider or supplier undertakes to enroll in the Medicare program and maintain enrollment in good standing, which includes, but is not limited to, initially enrolling, revalidating enrollment, and reporting changes of information as described within this chapter. A. Initial Enrollment In general, a provider or supplier shall enroll as an initial applicant if it is: • Initially enrolling in the Medicare program or enrolling as a provider or supplier in a new geographic jurisdiction. • Seeking to reestablish itself in the Medicare program after a voluntary withdrawal from the Medicare program, or subsequent to a termination or revocation of enrollment based upon any CMS authority under Title 42 of the CFR. For additional information, refer to sections of this chapter concerning unique provider and supplier types, the applications that correspond to Medicare enrollment by provider/supplier type and purpose, and a general discussion of enrollment topics. B. Revalidation Pursuant to 42 CFR §§ 424.515, 410.41(c), and 424.57(g), providers and suppliers use the CMS enrollment application process to periodically revalidate their Medicare enrollment record. Suppliers of durable medical equipment, prosthetics, orthotics, and supplies are required to revalidate every 3 years and all other providers and suppliers every 5 years. C. Changes of Information Consistent with 42 CFR § 424.516, providers and suppliers use the CMS enrollment application process to report changes of information as required to remain in compliance with the requirements to participate in Medicare.