Medicare soon will introduce a “stay of enrollment” status for physicians and others enrolled in the federal program, despite pushback from the Texas Medical Association.
The Centers for Medicare & Medicaid Services (CMS) created the stay status – a pause of up to 60 days due to simple paperwork mistakes or missed deadlines – as part of the 2024 Medicare Physician Fee Schedule. The status will take effect on June 3, according to a recent policy update from the federal agency.
CMS may implement a stay if an enrollee:
- Is noncompliant with at least one Medicare enrollment requirement; and
- Can remedy the noncompliance by submitting an applicable CMS form.
During a stay, physicians and others will remain enrolled in Medicare, but the public payer will reject any claims submitted with dates of service within the stay period.
A stay “represents a middle ground between (1) a deactivation and (2) non-action on CMS’ part,” according to the Medicare Program Integrity Manual. “It gives CMS greater flexibility to take appropriate, fair, and reasonable measures commensurate with the degree of the provider’s non-compliance.”
TMA disagreed, opposing the creation of the creation of the new status in a September 2023 comment letter to CMS.
“TMA cannot support the agency’s proposal not to pay providers or suppliers for services or items furnished to Medicare patients during the ‘stay of enrollment,’” TMA President Rick Snyder, MD, wrote. “Instead, we urge CMS to implement a process for providers or suppliers who submit the proper paperwork within the 60-day time frame to dispute Medicare non-payment decisions made during the [stay].”
For more information on Medicare enrollment options, including participating, non-participating, and opt-out, check out TMA’s Education Sheet “Medicare Participation: The Basics,” available to member physicians.
Last Updated On
March 13, 2024
Originally Published On
March 13, 2024
Emma Freer
Associate Editor
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