All Medicare providers must update their enrollment information to reflect changes in ownership (CHOWs) within 30 days after the CHOW.1 Providers must report CHOWs to the applicable Medicare Administrative Contractor (MAC). Typically, a provider’s MAC is merely determined by the provider’s covered services and payment location.2 A/B MACs process Medicare Part A and Medicare Part B claims for a defined geographic area or jurisdiction.3 However, in certain circumstances, a provider’s MAC may not be the currently assigned contractor in their jurisdiction.
Medicare providers that are currently or were previously part of an approved chain of two or more providers under common ownership or control may be enrolled with and assigned to a MAC outside their jurisdiction.4 Chain providers may request and receive an exception to the traditional MAC assignment, and, upon CMS approval, may enroll with and bill on behalf of the eligible providers under its common ownership or common control to the MAC for the geographic locale in which the qualified chain provider’s home office is physically located.5 CMS also has authority to grant an exception to the traditional MAC assignments to eligible providers that are not under the common ownership or common control of a qualified chain provider, as well as ineligible providers, if CMS finds the exception will support the implementation of MACs or will serve some other compelling interest of the Medicare program.6
It is important for providers and investors to know their current MAC to prevent delays with reporting and processing CHOWs. Failure to timely report a CHOW, including changes in individuals or organizations with 5% or greater ownership or controlling interests, may result in termination of a provider’s Medicare provider agreement and revocation of Medicare billing privileges.7 In addition, delays in reporting CHOWs can result in the provider having to hold Medicare claims from the effective date of the CHOW until Medicare has processed and approved the CHOW.
[1] 42 C.F.R. § 424.516.
[2] 42 C.F.R. § 421.404(b).
[3] See CMS, Who are the MACs, https://www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/Who-are-the-MACs.
[4] 42 C.F.R. § 421.404(a).
[5] 42 C.F.R. § 421.404(b).
[6] Id.
[7] 42 C.F.R. 424.516.
