CMS has issued a Change Request, number 13449, titled “Stay of Enrollment”, and it is crucial that home health and hospices agencies, as well as other suppliers such as Physicians and Durable Medical Equipment (DME) providers all understand this request.

For home health and hospice providers, it’s essential to grasp that a “Stay of Enrollment” indicates that your Medicare enrollment is on hold. This pause results in the zero payment of all claims until compliance is attained.

The Change Request highlights two main reasons that could impact home health and hospice providers. First, if you don’t promptly report a change of address, and second, if you fail to respond to a revalidation request. Both scenarios could impact your enrollment status.

Revalidation has been a standard process for a few years. If your Medicare Administrative Contractor (MAC) contacts you for revalidation and you don’t respond, they’ll initiate a Stay of Enrollment.

Previously, if there were issues with your organization, they could completely deactivate your billing privileges, a process that would take a considerable amount of time to restore. This new Stay of Enrollment is a temporary hold that can be quickly reversed, which is a positive development. However, the downside is that this hold can be triggered simply because you didn’t submit a Change of Address or failed to respond to a revalidation request. This makes the process more sensitive, posing significant risks if not managed properly.

It’s important that you take this information seriously as hospice agencies are already experiencing Stays of Enrollment in early May. This is concerning, as the Change Request notes that it is not slated to take effect until May 30. The fact that some organizations are already being affected means agencies need to ensure their address is current and that revalidation requests are responded to promptly.

Be aware that these aren’t the only two reasons that could lead to a Stay of Enrollment. If you are found to be non-compliant with any enrollment requirements, it could trigger this status. Essentially, any changes that would require you to file an 855 form to update your Medicare information might result in a Stay of Enrollment if not properly addressed.

Should you need any assistance with understanding Change Request 13449, or triggers that could lead to a Stay of Enrollment, please don’t hesitate to reach out to us.

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