Physicians who choose to participate in Medicare must enroll with the program in order to submit claims for reimbursement. Part of the enrollment and re-enrollment application prompts physicians to disclose specific information about any billing agencies that the physician uses to submit claims to Medicare.
As part of a broader effort to reduce fraud and abuse in Medicaid, the Patient Protection and Affordable Care Act prompts each State to require “any agent, clearinghouse, or other alternate payee that submits claims on behalf of a health care provider must register with the State and the Secretary [of U.S. Department of Health and Human Services].” Sec. 6503. To clarify, the federal registration will most likely be handled by CMS.
Federal rules detailing this new billing agent registration process and defining the term “alternate payee” have not yet emerged. In North Carolina, the Division of Medical Assistance is currently working with stakeholder groups, including the North Carolina Medical Society, to identify straightforward options for how this new requirement will be folded into Medicaid.
This provision of the PPACA takes effect January 1, 2011. However, if legislation is required for the State to implement this provision, then the effective date may be pushed later into 2011. NCMS will update this article as more information becomes available.