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CMS to charge $505 enrollment fee for some providers

DecisionHealth stock imageYou will have to pony up $505 per provider to enroll them for Medicare billing privileges -- but only if you are an "institutional provider." This category basically refers to any provider who is enrolling to supply durable medical equipment, prosthetics, orthotics and supplies (DMEPOS). Most notably, physicians, non-physician practitioners (NPP) or groups of either that are not DMEPOS suppliers don't have to pay the fee.

The news surfaced in Transmittal 371 to the Medicare Program Integrity Manual, released March 23. The $505 amount is effective from March 25 through Dec. 31 and will be adjusted in the future, based on percentage change of the consumer price index. CMS will of course issue advance notice on fee changes. The fee reflects a provision in the health reform law.

NOTE: It's not just new enrollment that now requires the fee. Revalidating providers and adding practice locations also will incur the $505 cost per provider. You can attempt to claim a hardship exemption, though CMS doesn't offer much in the way of hard and fast rules on what qualifies, beyond that it's a hardship if the fee represents a "significant burden for an adeuqately capitalized provider or supplier."

Remember: Physician practices don't pay this fee unless they are newly enrolling or validating a DME provider number, says Leslie Witkin, president of Physicians First in Orlando.
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