Provider Enrollment & Privileging Flashcards
7 cards from real CHCS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Provider Enrollment & Privileging flashcards as text
How often must most Medicare providers and suppliers revalidate their enrollment?
Answer: Every 5 years
Most providers revalidate every 5 years, while DMEPOS suppliers revalidate every 3 years.
How often must a practitioner re-attest their CAQH ProView profile to keep it active?
Answer: Every 120 days
CAQH ProView requires re-attestation every 120 days.
A physician's Medicare enrollment is approved, and the application was filed on June 30. What is the earliest date they can usually bill retroactively?
Answer: May 31, 30 days before filing
Physicians and NPPs may bill retroactively up to 30 days before the effective filing date if they met all requirements then.
How long does a physician's Medicare opt-out last before it renews automatically unless canceled?
Answer: 2 years
Opt-out periods run for 2 years and renew automatically unless the physician cancels at least 30 days before the period ends.
Which institutional provider type must generally pay a Medicare enrollment application fee?
Answer: Hospital or other institutional provider
Institutional providers pay the application fee, while individual practitioners and physician/NPP groups are exempt.
Which database must be checked to confirm that a provider is not excluded from federal healthcare programs?
Answer: OIG LEIE
The OIG List of Excluded Individuals/Entities identifies people barred from federal healthcare programs.
Under Medicare's fee-for-time rules, a locum tenens physician may usually cover for an absent physician for how long continuously?
Answer: 60 days
Medicare limits fee-for-time (locum tenens) billing to 60 continuous days, with limited exceptions.
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