Like patients, physicians and nonphysician practitioners (NPPs) must maintain their enrollment in Medicare and Medicaid. The COVID-19 public health emergency (PHE), which ended on May 11, and other procedural changes have impacted these processes.
Medicare
Starting Nov. 1, physicians and NPPs who care for Medicare patients and don’t use the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) must use a revised form to enroll or update their information.
The revised form, CMS-8551 (Medicare Enrollment Application – Physicians and Non-Physician Practitioners), includes the following changes that:
- Discontinue the paper version of the application;
- Remove physician assistant employer arrangements;
- Recognize physicians and NPPs who provide acupuncture services;
- Identify licenses under the Interstate Compact licenses;
- Add new physician specialties; and
- Expand practice location types to include telehealth.
Through Oct. 31, Medicare administrative contractors will accept current and revised versions of the form, according to the Centers for Medicare & Medicaid Services (CMS). To enroll and update your information more quickly and easily, CMS recommends physicians and NPPs use PECOS.
For more information, check out CMS’ instructional guide to the revised form.
Medicaid
Under the Affordable Care Act, physicians must revalidate their enrollment in state Medicaid programs, including Texas’, at least every five years via the Provider Enrollment and Management System (PEMS).
Physicians and NPPs who were due to re-up their enrollment between March 1, 2020, and May 11, 2023, will receive a grace period after the PHE to complete their revalidation, according to the Texas Medicaid & Healthcare Partnership (TMHP).
The partnership has sent an email to those affected with a recalculated revalidation due date. Physicians and NPPs can find their revalidation due dates in PEMS, and the Texas Health and Human Services Commission recommends they submit revalidation applications at least 120 days before the end of their enrollment period to ensure enough time for processing.
As of June 13, TMHP also now requires physicians and NPPs to review and update their practice addresses in PEMS.
For more information and to begin your revalidation in PEMS, check out the
TMHP website.
Emma Freer
Associate Editor
(512) 370-1383