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

CMS-1403-FC
precluded enrollment in advance of providing services to
Medicare beneficiaries.
While these changes limit the retrospective payments
that a physician, NPP, or physician and NPP organization
may obtain from the Medicare program, we believe that this
approach will ensure that a Medicare contractor is able to
verify that a physician, NPP or physician and NPP
organization meets all program requirements at the time of
filing, including State licensure. In addition, this
approach will afford Medicare beneficiaries the appropriate
protections under the statute, regulations, and CMS policy.
To ensure that eligible physicians, NPPs or physician
and NPP organizations receive reimbursement for services
furnished, we will require that Medicare contractors deny
Medicare billing privileges when a Medicare contractor is
not able to process an incomplete enrollment application
that is submitted by a physician, NPP or physician and NPP
organization. This is a change from our earlier final
rule, “Medicare Program; Requirements for Providers and
Suppliers to Establish and Maintain Medicare Enrollment,”
(CMS-6002-F) which was published on April 21, 2006. In
this earlier rulemaking effort, we stated that we would
reject an incomplete enrollment application. In order to
provide physician and NPP organizations and individual
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