American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Enrollment Steps

How can surgeons enroll as a Medicare participating provider?

Surgeons must complete several steps to successfully participate in the Medicare program:

Step 1: Submit a Medicare Provider Enrollment Application

Providers must be assigned an NPI before enrolling in the Medicare Program. Visit the National Plan and Provider Enumeration System website to apply for an NPI.

Once an NPI is obtained, providers can submit either a paper enrollment application or complete an electronic enrollment application through the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) online portal.

Providers submitting an enrollment application must pay an application fee electronically via PECOS. Applications will be rejected if the fee, which varies year to year, is not paid within 30 days of the application submission. Providers must make their 2020 Medicare participation determination by December 31, 2019. Participation agreements will cover the period from January 1, 2020 through December 31, 2020, and may not be changed once open enrollment has ended (with limited exceptions).

Before submitting an enrollment application, providers should ensure that:

  • All required forms are appropriately signed and dated
  • All data elements completed accurately
  • Supporting documents (e.g., tax forms, proof of licensure) are attached
  • Application fees are paid

Step 2: Await Application Processing

Medicare Administrative Contractors (MACs) process and screen all provider information on the enrollment application once it is submitted. MACs perform verification of licensure and database checks for all applicants, and may employ additional review methods (e.g., documentation requests, site visits) as needed. Failure to respond within 30 days of a MAC’s request for additional information will result in the rejection of an application.

Once a provider has been determined by a MAC to be eligible under Medicare rules and regulations to be granted Medicare billing privileges, the provider will receive an approval letter and will be designated as “approved” on PECOS.

Step 3: Finalize Enrollment

Providers whose enrollment applications are approved must submit the Medicare Participating Physician or Supplier Agreement (CMS-460) to the appropriate MAC in order to finalize their enrollment. Providers have 90 days from when the CMS-460 form is submitted to decide to maintain their participation status or revoke their enrollment. Once a provider becomes a Medicare participant, they must remain a participant until the following annual enrollment period conducted by their MAC.

Step 4: Keep Your Information Up to Date

Providers must revalidate their Medicare enrollment record information every five years using PECOS or the appropriate paper application. Providers who are actively enrolled in Medicare may check the Medicare Revalidation Lookup Tool to find their revalidation due date and verify the accuracy of their enrollment information that exists on file with Medicare.

In the event that a provider experiences a change of information (e.g., change of practice address or ownership) after their revalidation due date, they should update their record in PECOS within 30 days of the reportable event.

For more information about the Medicare provider enrollment process, review the Centers for Medicare & Medicaid Services’ (CMS) enrollment guide.

When can surgeons enroll in or make changes to their Medicare participation agreements?

MACs conduct an annual open participation enrollment period in order to offer providers an opportunity to make their calendar year Medicare participation decision. During open enrollment, which typically occurs from mid-November through December 31 each year, providers can choose to enroll in the Medicare program, maintain their participation status, or modify their participation status. Providers must make their 2019 Medicare participation determination by December 31, 2018. Participation agreements will cover the period from January 1, 2019 through December 31, 2019, and may not be changed once open enrollment has ended (with limited exceptions).