Notice: This CMS-approved document has been submitted - Philips ...

CMS-1403-FC
prior to their enrolling in the Medicare program. In the
proposed rule, we stated our concern that some physician
and NPP organizations and individual practitioners may bill
Medicare for services when they are not meeting our other
program requirements, including those related to providing
beneficiary protections, such as Advance Beneficiary
Notices.
We solicited public comment on two approaches for
establishing an effective date for Medicare billing
privileges for physician and NPP organizations and for
individual practitioners.
The first approach would establish the initial
enrollment date for physician and NPP organizations and for
individual practitioners, including physician and NPPs, as
the date of approval by a Medicare contractor. This
approach would prohibit physician and NPP organizations and
individual practitioners from billing for services
furnished to a Medicare beneficiary before they are
approved and enrolled by a designated Medicare contractor
to participate in the Medicare program and Medicare billing
privileges are conveyed to their National Provider
Identifier (NPI). Physicians and NPPs are eligible for
NPIs and may apply for their NPIs at any time. To enroll
in Medicare, a physician or NPP must have an NPI. If an
225