Stay of Enrollment

The individual provider or authorized/delegated official of a group/facility agrees to adhere to all Medicare requirements when enrolling.

CMS implemented a preliminary, interim status representing a pause in enrollment called a “Stay of Enrollment” or “Stay." A stay is a CMS action that’s less burdensome on providers and suppliers than a deactivation or revocation of your Medicare enrollment when not in compliance.

As outlined in section 424.541(a)(1)(i) and (ii), there are two requirements for a stay’s implementation. Specifically, the provider:

• Is noncompliant with at least one enrollment requirement in Title 42; and
• Can remedy the noncompliance via the submission of, as applicable to the situation, a Form CMS-855, Form CMS-20134, or Form CMS-588 change of information or revalidation application (hereafter occasionally and collectively referenced as “the applicable CMS form” or “ACF”)

Note: It’s important to understand that if the type of noncompliance involved cannot be corrected via the submission of an ACF, a stay cannot be imposed.

Once the stay is implemented on your enrollment, all claims will be rejected, and a notification letter will be mailed to the correspondence address identified on the enrollment requesting a ACF be submitted to remedy the non-compliance before the MAC must deactivate enrollment and/or revoke Medicare billing privileges.

Once we receive the ACF, the stay will be lifted from the enrollment; however, the application will still need to be processed for approval. If additional information is needed while processing the application, please respond timely to prevent further action on your enrollment for the noncompliance.

Related Content

• CR 13449 Stay of Enrollment 100-08 Chapter 10.4.9
• MLN Matters® CR 13449 Stay of Enrollment

Posted 5/15/2024