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Resources for Providers

FOR PROVIDERS

Providers

Find your MAC: Do you know our Medicare Administrative Contractors (MACs) can help you enroll or re-enroll, understand billing requirements, and answer other administrative questions you may have about Medicare? Different MACs are responsible for different regions. Access a list of CMS contractors in your state and find your MAC today.

Become a Medicare Provider: Are you a provider interested in serving Medicare patients? In order to bill Medicare, you must be enrolled. You can apply via the standard paper forms or choose the most efficient method and submit your enrollment application online through PECOS, CMS’ provider enrollment system. Read more about the enrollment process here.

Revalidate your Medicare Enrollment: Already a Medicare provider? Be sure to revalidate your Medicare enrollment. Medicare providers, who typically must revalidate their enrollment every 5 years, will receive notification that their revalidation date is approaching. You can check your revalidation due date now, learn more about the different revalidation methods (online or paper), or get started on your revalidation today with PECOS, the online provider enrollment system. Refer to our revalidation application checklist to know what you need before getting started.

Withdraw from Medicare: We are sorry to see you go. When a physician or non-physician practitioner retires, surrenders his or her license for any reason, or chooses to no longer participate in the Medicare program, he/she should voluntarily withdraw from the Medicare program. Withdrawing from Medicare is considered a change, and should be reported within 90 days. You can report this change online through PECOS.

Update or get a new National Provider Number (NPI): Need an NPI? Do you have one and want to make sure your information is up to date? Log in to the NPI system, known as NPPES, to get started.

See the changes we've made to medical reviews: When claims are submitted accurately, everyone benefits. Learn how the new Targeted Probe and Educate (TPE) program better targets medical reviews, limits the number of claims requested, and puts an emphasis on education and assistance to correct claims.

Check your Open Payments data: Do you have payments reported in the Open Payments database? Find out on the Open Payments website or if you already have an account, log in to the portal to review.

Sign up for compliance updates: Subscribe to the provider compliance email list and be the first to know about events and opportunities to collaborate with CMS and your fellow providers.

Resources for States

FOR
STATES

States

See how states are addressing the opioid epidemic: Want to know how other states are addressing program integrity vulnerabilities produced, in large part, by opioid misuse and abuse? The Medicaid Integrity Institute (MII) Compendium of Promising Practices provides insight into what many consider the four major vulnerabilities and describes mitigation strategies that are being used - or can be used in the future - to address them.

Join the Healthcare Fraud Prevention Partnership: Learn how sharing data with others in the healthcare industry, both public and private entities, can help your organization identify and reduce fraud, waste, and abuse across the healthcare sector. Learn more about the HFPP and find out how to become a partner.

Learn the latest in fraud schemes and detection: The Medicaid Integrity Institute (MII) exists to educate and train our state partners. Located in Columbia, South Carolina and developed by CMS in partnership with the Department of Justice, MII brings together experts - including law enforcement - to deliver up-to-date information on trends and strategies. See the latest course offerings on the MII website.

Find guidance on federal Medicaid enrollment standards: The Medicaid Provider Enrollment Compendium (MPEC) is one of many resources available to state Medicaid agencies on Medicaid.gov's Medicaid program integrity resources page. Specifically, the MPEC provides guidance and clarification to help Medicaid agencies comply with regulations around Disclosure of Information by Providers, and Fiscal Agents and Provider Screening and Enrollment.

Resources for Partners

FOR
PARTNERS

Partners

Join the Healthcare Fraud Prevention Partnership: Learn how sharing data with others in the healthcare industry, both public and private entities, can help your organization identify and reduce fraud, waste, and abuse across the healthcare sector. Learn more about the HFPP and find out how to become a partner.

New Medicare cards have arrived! By now, all people on Medicare should have received their new cards. We removed the Social Security number (SSN) from all Medicare cards and issued new ones with a new, non-SSN ID. But just because the cards are all mailed doesn't mean the fraud schemes stop. Anyone suspecting healthcare fraud, waste or abuse is encouraged to report it. Our Reporting Fraud page lists the different options for doing so.

Check the Open Payments data: The Open Payments program publishes information about payments made to providers and teaching hospitals by the pharmaceutical and medical device industries. Find out more on the Open Payments website.

CONNECT WITH US

Connect with CPI as we host or attend various events throughout the year, join the conversation on Twitter around subjects that matter to all of us, or find the most appropriate vehicle to report suspected fraud, waste or abuse.

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