Here is a heart stopper … CMS recently removed corrective action plans as an option to cure certain non-compliance errors. That makes it much more difficult to recover from a Medicare PTAN revocation. Fortunately, CMS also created a new interim suspension status for compliance violations that will give suppliers some hope of staying in the Medicare program when problems arise with their enrollment status. It is called a stay of enrollment.

Next Episode: Thursday, June 20, 2024

What is a Stay of Enrollment? A stay of enrollment suspends Medicare activity when the National Provider Enrollment (NPE) contractor believes a supplier is not complying with all supplier standards. This will be far less burdensome than deactivation or revocation because:
  • The supplier remains enrolled in Medicare, and the PTAN is active.
  • Suppliers may continue to work claims for dates of service before the start of the stay of enrollment.
  • Stays are not considered adverse legal actions that must be reported on future enrollment applications.
Moreover, claims reject during the stay of enrollment, so suppliers can simply resubmit them as soon as the stay is lifted. Claims submitted under revocation, on the other hand, deny for medical necessity and must go through a lengthy appeal process. Stay of Enrollment Conditions Suppliers are only eligible for stays of enrollment when the submission of a form 855-S (enrollment application) or 588 (EFT/Direct Deposit) will cure the non-compliance issue. Examples include:
  • Failures to report changes in information (e.g. missing product disclosures, unreported address changes), and
  • Non-responses to revalidation requests.
Suppliers are not eligible for stays of enrollment for compliance violations that cannot be resolved with updated enrollment filings. Examples include:
  • Felony conviction of an owner.
  • Non-compliance with required licensure.
  • Lapsed surety bonds.
Compliance violations that are ineligible for a stay of enrollment are immediately subject to deactivation or revocation. Notification and Response We anticipate NPEs will implement the stay of enrollment in June 2024. Thereafter, contractors will send stay notifications via regular mail to the address listed in the PECOS enrollment record. However, if that address is not current, suppliers cannot use failure to receive a notice as a rationale for not responding. NPE contractors will also send duplicate notices via fax and email if those contact details are included in the PECOS record. In general, suppliers have 30 days from the date of the notice to respond. CMS can adjust the response time at its discretion, so it is important to read the notice carefully. Stays of enrollment cannot be extended or renewed. In the end, I think suppliers will find the stay of enrollment a welcome pathway to curing simple violations that slip through the cracks.