Medicare Eligibility Information for Providers

Health service providers, such as physicians and practitioners, can enroll in the Medicare program and provide its services to patients. To offer Medicare, you must have a provider agreement with the Centers for Medicare and Medicaid Services.

Types

Providers that can offer Medicare include hospitals, critical access hospitals, skilled nursing facilities, hospices, home health agencies and comprehensive outpatient rehabilitation facilities. Clinics, rehabilitation agencies and public health agencies can furnish outpatient therapy services, and community mental health centers can furnish partial hospitalization services.

Considerations

To provide Medicare services to patients, a provider must agree to certain terms. It must limit charges to beneficiaries and return overcharged money, identify primary payers other than Medicare and reimburse Medicare for overcharged amounts when it receives money from additional payers. CMS may enforce additional terms, depending on the type of provider.

Warning

Medicare providers have a lawful obligation to follow the CMS program requirements. Providers who commit fraud and abuse may face prosecution resulting in restitution, fines, imprisonment and administrative sanctions, and will lose eligibility to provide Medicare.