Due to the COVID-19 global pandemic, The Centers for Medicare and Medicaid Services (CMS) has announced that it is scaling back on provider enrollment restrictions. CMS is practicing its waiver authority for physicians and non-physician practitioners, or NPPs to help expedite the enrollment process, which can be located in the Social Security Act Section 1135.

CMS has established toll-free hotlines to enroll and receive temporary Medicare billing privileges during this time. Any providers looking to streamline the enrollment process should contact their geographic area’s Medicare Administrative Contractor (MAC) hotline. CMS is waiving all application fees after March 1, 2020. CMS will also be temporarily waiving these screening requirements to get providers enrolled quickly:

  • Criminal background checks associated with fingerprint-based criminal background checks (FCBC) – 42 C.F.R 424.518 (to the extent applicable)
  •  Site visits – 42 C.F.R 424.517 
  • Postpone all revalidation actions 

For CMS to authorize the 1135 waiver for a physician or NPP, these four conditions must be met:

  • The physician or NPP must be enrolled as such in the Medicare program
  • The physician or NPP must possess a valid license to practice in the state which relates to their Medicare enrollment
  • The physician or NPP is furnishing services, either in person or telehealth, in a state which the emergency is occurring in order to contribute to relief efforts in his or her professional capacity
  • The physician or NPP is not affirmatively excluded from practice in the state or any other state that is apart of the 1135 emergency area

MAC hotlines will be open Monday through Friday with varying hours per contractor. Find their hours and hotline number: https://www.cms.gov/files/document/provider-enrollment-relief-faqs-covid-19.pdf

Providers should have all of the following information available before calling the hotline:

  • National Provider Identifier (NPI)
  • Social Security Number
  • A valid in-state or out-of-state license
  • Contact information

Approval or rejection of the temporary Medicare billing privileges will be determined during the phone call. A follow-up email will also be sent from the respective MAC confirming the approval or rejection of the privileges.

If you’d like to learn more about the provider enrollment relief program, visit: https://www.cms.gov/files/document/provider-enrollment-relief-faqs-covid-19.pdf

To locate your Medicare Administrative Contractor (MAC), visit: https://www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/Downloads/MACs-by-State-June-2019.pdf