Become an Institutional Provider
Guidance for Medicare Enrollment for Hospitals, Critical Care Facilities, Skilled Nursing Facilities, Home Health Agencies, Hospices, or Other Similar Institutions on Becoming An Institutional Provider
Final
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: August 31, 2020
Become an Institutional Provider
Use this guide if you are enrolling a hospital, critical care facility, skilled nursing facility, home health agency, hospice, or other similar institution.
Rural Emergency Hospitals (REHs)
CMS implemented a new REH provider type on Jan. 1, 2023. If you're converting a rural hospital or critical access hospital to an REH, the REH Medicare Provider Instructions (PDF) will give you the information you need to submit your application.
Medicare Enrollment Guide for Institutional Providers
Your institution’s authorized official will need to complete the steps in this enrollment guide. If the authorized official doesn’t have an account with the Identity Access & Management System, they can create one on the Identity Access & Management System website.
Step 1: Get an NPI
If you already have an NPI, skip this step and proceed to Step 2.
NPIs are issued through the National Plan & Provider Enumeration System (NPPES). You can apply for an NPI on the NPPES website. Not sure if you have an NPI? Search the NPI Registry.
Step 2: Complete the Medicare Enrollment Application
Enroll using PECOS,i the online Medicare enrollment system. PECOS has video and print tutorials and will walk you through your enrollment to ensure your information is accurate. Complete the online PECOS application.
Step 3: Pay the Medicare Application Fee
The Medicare Application Fee for 2023 is $688. You can pay the fee on the PECOS Medicare Fee Payment page.
Step 4: Work With Your MAC and the State Agency
Medicare Administrative Contractors (MACs) process all Medicare applications for institutional providers. After you submit your enrollment application, your MAC will make a recommendation for approval to the State Agency and CMS Location. The State Agency may conduct a survey of your facility.ii
Once you’ve signed a provider agreement and the CMS Location has made the final determination regarding your enrollment, the CMS Location will share the determination with your MAC. Your MAC may order a site visit from the National Site Visit Contractor.
You can check in with your CMS Location regarding your enrollment status. Contact Your CMS Location (PDF).
Keep Your Information Current
It’s important to keep your enrollment information up to date. To avoid having your Medicare billing privileges revoked, be sure to report the following changes within 30 days:
- a change in ownership
- an adverse legal action
- a change in practice location
You must report all other changes within 90 days. If you applied online, you can keep your information up to date in PECOS. If you applied using a paper application, you’ll need to resubmit your form to update information.
Need Help With Your Enrollment?
Your MAC can help you navigate the enrollment process and answer questions about your application. Contact your MAC (PDF).
i If you’re unable to apply online using PECOS, you can use a paper application form.
ii If your institution has obtained accreditation from a CMS-approved accreditation organization, you will not need to participate in State Survey Agency surveys. You must inform the State Survey Agency that your institution is accredited. Accreditation is voluntary; CMS doesn’t require it for Medicare enrollment. For more information, visit the Accreditation of Medicare Certified Providers & Suppliers page.
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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.