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CMS-1403-FC
and NPP organizations, physicians, NPPs or IDTFs. We
revised this provision so that it is consistent with
§424.521 which limits the ability of these suppliers to
bill Medicare retrospectively.
J. Physician and Nonphysician Practitioner (NPP)
Enrollment Issues
1. Effective Date of Medicare Billing Privileges
In accordance with §424.510, physician and NPP
organizations (that is, groups, clinics, and sole owners)
and individual practitioners including physicians and NPPs,
operating as sole proprietorships or reassigning their
benefits to a physician and nonphysician organization may
submit claims as specified in §424.44 after they are
enrolled in the Medicare program. This provision permits
newly enrolled physician and NPP organizations and
individual practitioners, as well as existing physicians
and nonphysician organizations and individual practitioners
to submit claims for services that were furnished prior to
the date of filing or the date the applicant received
billing privileges to participate in the Medicare program.
For the purposes of this final rule with comment
period, we believe that an NPP includes, but is not limited
to, the following individuals: anesthesiology assistants,
audiologists, certified nurse midwives, certified
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