By: Christopher A. Parrella, Esq., CPC, CHC, CPCO
Parrella Health Law, Boston, Ma.
A Health Law Defense and Compliance Firm

On May 30, 2024, a new rule from the Centers for Medicare & Medicaid Services (CMS) will go into effect, introducing a “stay of enrollment” status for Medicare providers. This new status, outlined in MLN Matters Number: MM13449, aims to provide a less burdensome alternative to deactivation or revocation of Medicare enrollment for providers who are non-compliant with enrollment requirements but can remedy the issue by submitting the appropriate CMS forms.

What is a Stay of Enrollment? A “stay of enrollment” is an interim status representing a pause in a provider’s Medicare enrollment due to non-compliance with at least one Medicare enrollment requirement. The non-compliance can be corrected by submitting applicable CMS forms (CMS-855, CMS-20134, or CMS-588). If the non-compliance cannot be corrected by submitting these forms, a stay cannot be imposed.

Key Points of a Stay:

• Providers remain enrolled in Medicare during the stay.
• Claims submitted with dates of service within the stay period will be rejected.
• A stay lasts no longer than 60 days but can be shorter.
• A stay is not considered an adverse legal action.
• Multiple stays can be imposed for separate instances of non-compliance.

Examples of Non-Compliance Which May Lead to a Stay of Enrollment:

• Failing to report a change of address timely.
• Not responding to a revalidation request.
• Not reporting the deletion of a managing employee.
• Failing to report a change in a practice location’s ZIP code.

Non-compliance with supplier standards that can be remedied by submitting the appropriate CMS 855 applications and forms.

Rebuttal Process: Providers may file a rebuttal to show they met all applicable enrollment requirements and that the stay should not have been imposed. Only one rebuttal request per enrollment stay is allowed.

Notification: Medicare Administrative Contractors (MACs) will notify providers of a Stay by hard-copy mail, email, and fax if available.

This new “stay of enrollment” status provides a more flexible and less punitive approach for providers to address enrollment issues without the severe consequence of having the Medicare provider agreement terminated. It underscores the importance of maintaining compliance with all Medicare enrollment requirements while offering a pathway to rectify issues promptly.

If you have any questions about this new enrollment rule or need assistance with Medicare enrollment compliance, contact Parrella Health Law at 857-328-0382 or email me cparrella@parrellahealthlaw.com. Our team is here to help navigate these regulatory changes and ensure your practice remains compliant.

Christopher Parrella, ESQ, CPC, CHC, CPCO, is the founding partner of Parrella Health Law in Boston, Mass. The firm focuses exclusively on healthcare defense and compliance matters. Chris also travels the country on behalf of a wide range of healthcare organizations, lecturing on a variety of health care enforcement and compliance topics. Chris is one of a handful of health care attorney’s that are also Certified Professional Coders (CPC) and is a member of the AAPC’s National Legal Advisory Board and Ethics Committee.  He is also a Certified Professional Compliance Officer (CPCO) and Certified in Health Care Compliance (CHC.)