10/03/2022

Failure to Update Your Information with Medicare Could Cost You Money!

Avoid Disruption of Medicare Claims Payments – Physicians Required to Report Any Change of Ownership, Adverse Legal Action, or Change in Practice Location Within 30 Days

The Centers for Medicare & Medicaid Services (CMS) requires Medicare providers to keep their enrollment information current at all times. Under federal law, all physicians and non-physician practitioners are required to report the following changes in their enrollment information to their Medicare Administrative Contractor (MAC) – in the case of Michigan physicians, to WPS Medicare – within 30 days of:

• A change in ownership
• An adverse legal action
• A change in practice location

Failure to report these changes could have serious consequences, up to and including the revocation of Medicare enrollment.

These changes must be reported to the physician’s MAC via the Internet-based Provider Enrollment, Chain and Ownership System (PECOS) or the CMS 855 paper enrollment application, as follows:

• CMS 855I (for Physicians and Non-Physician Practitioners)
• CMS 855B (for Clinics and Group Practices)

Note: PECOS is the preferred method for submitting initial applications or making address changes to your provider file.

All other changes to Medicare enrollment must be reported within 90 days of the change. This could include a change in your Tax ID#, billing agency, a change in the managing employee or organizational structure – anything that differs from the initial enrollment application or last information reported to CMS, if information has already been updated from the initial application.