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Definitions Related to Enrollment
Applicant:
The individual practitioner/provider/supplier who is applying for
the Medicare number.
Authorized Official:
An appointed official to whom the provider/supplier has granted the
legal authority to enroll it in the Medicare program, to make changes
and/or updates to its status in the Medicare program (e.g., new practice
locations, change of address) and to commit the provider/supplier to
fully abide by the laws, regulations, and program instructions of
Medicare. The authorized official must be the provider's/supplier's
general partner, chairman of the board, president, chief financial
officer, or chief executive officer, or must hold a position of similar
status and authority within the provider/supplier. An authorized
official can also be anyone who is a direct owner of 5 percent or more
of the provider/supplier. An entity can have only one designated
authorized official at one time.
Bankruptcy:
When a provider/supplier files for protection in a Federal bankruptcy
court, it may choose, with the permission of the court, to cease
operations (Chapter 7) or reorganize (Chapter 11). When a
provider/supplier files under Chapter 7, it will liquidate its assets
and cease operations and must notify the contractor of this fact. When
the assets are sold to a different entity, that entity must enroll with
the contractor if it wishes to bill the Medicare program.
Billing Agency:
A company that the applicant
contracts with to prepare or to edit the content of the claim.
Delegated Official:
An individual who has been delegated the
legal authority by the authorized official of that provider/supplier to
make changes and/or updates to the organization's status in the Medicare
program (e.g., new practice locations, change of address) and to commit
the provider/supplier to fully abide by the laws, regulations and
program instructions of Medicare.
Divestiture:
The act of a provider/supplier selling off part or all of its
assets, whether voluntarily or by court order. Whether or not a
divestiture constitutes a change of ownership (CHOW) for a provider
depends on the structure of the transaction.
Inactivate:
The provider/supplier will be unable to use its billing number for
claims processing. Upon taking this action, Medicare Services will
notify the applicant of the reason.
Joint Venture:
A business undertaking involving a one-time grouping of two or more
entities. Although a joint venture is treated like a partnership for
Federal income tax purposes, it is different from the latter in that it
does not involve a continuing relationship among the parties. Joint
ventures are, in a sense, short-term partnerships. In a joint venture
where there is no transfer of legal title of assets, no CHOW occurs.
Legal Business Name:
The name that is reported to the Internal Revenue Service (IRS).
Medicare Identification Number:
A generic term for any number that uniquely identifies the enrolling
individual or organization. Some examples of Medicare identification
numbers include: Unique Physician Identification Numbers (UPINs),
Provider Identification Numbers (PINs), Online Survey Certification and
Reporting (OSCAR) numbers, and National Supplier Clearinghouse (NSC)
numbers.
Mobile Facility/Portable Unit:
These terms apply when a service
that requires medical equipment is provided in a vehicle, OR the
equipment for the service is transported to multiple locations within a
geographic area. The most common types of mobile facilities/portable
units are mobile independent diagnostic testing facilities, Portable
X-ray units, portable mammography units and mobile clinics. Physical
therapists and other medical practitioners (e.g., physicians, nurse
practitioners, physician assistants) who perform services at multiple
locations (e.g., house calls, assisted living facilities) are not
considered mobile facilities/portable units.
Provider:
A hospital, critical access hospital, skilled nursing facility,
comprehensive outpatient rehabilitation facility, home health agency or
a hospice that is seeking to have in effect an agreement to participate
in Medicare; or a clinic, rehabilitation agency or public health agency
that is seeking in effect a similar agreement, but only to furnish
outpatient physical therapy or speech pathology services; or a community
mental health center that is seeking in effect a similar agreement but
only to furnish partial hospitalization services.
Supplier:
A physician or other practitioner, or an
entity other than a provider, that furnishes health care services under
Medicare.
Tax Identification Number:
The number that the individual or organization uses to report tax
information to the IRS, such as a Social Security Number (SSN) or
Employer Identification Number (EIN). |
