Corporate Compliance

Q&A: What is a reportable event?

Compliance Monitor, December 10, 2008

Q: What is a reportable event?

A: A reportable event is any change that affects information in a Medicare enrollment record. A reportable event may affect claims processing, claims payment, or a physician’s or non-physician practitioner’s eligibility to participate in the Medicare program. 

Effective January 1, 2009, physicians and non-physician practitioners are required to report these changes within 30 days of the reportable event:
  • Change in ownership
  • Change in practice location
  • Final adverse action 
A final adverse action includes:
  • Medicare imposed revocation of any Medicare billing privileges
  • Suspension or revocation of a license to provide healthcare by any state licensing authority
  • Revocation or suspension by an accreditation organization
  • Conviction of a federal or state felony offense (as defined in 42 CFR 424.535(a)(3)(i)) within the last 10 years preceding enrollment, revalidation, or re-enrollment
  • Exclusion or debarment from participation in a federal or state healthcare program 
Physicians and non-physician practitioners are required to report the following changes immediately, but not later than 90 days, after the reportable event: 
  • Change in practice status (e.g., retirement, voluntary surrender of medical license or voluntary withdrawal from the Medicare program)
  • Change of business structure, legal business name or taxpayer identification number
  • Banking arrangements or payment information
  • A change in the correspondence or special payments address
 This question and answer appear on the Frequently Asked Questions section of the CMS Web site.

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