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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). |