Medicare Provider | Practical Law

Medicare Provider | Practical Law

Medicare Provider

Medicare Provider

Practical Law Glossary Item w-024-4861 (Approx. 4 pages)

Glossary

Medicare Provider

A physician, non-physician practitioner (NPP), supplier, or health care facility that has an agreement with the Centers for Medicare and Medicaid Services (CMS) to participate in Medicare to provide health care services and supplies to Medicare beneficiaries. It is a CMS term of art and defined differently under Medicare Part A and Medicare Part B, though generally defined at 42 C.F.R. § 400.202.
Under Medicare Part A, Medicare providers are health care facilities or institutional providers, including:
  • Community mental health centers.
  • Comprehensive Outpatient Rehabilitation Facilities.
  • Critical Access Hospitals.
  • End-stage renal disease facilities.
  • Federally Qualified Health Centers (FQHCs).
  • Histocompatibility laboratories.
  • Home health agencies (HHAs) (including sub-units).
  • Hospices.
  • Hospitals (including acute care psychiatric, rehabilitation, and long-term inpatient services).
  • Indian Health Service Facilities.
  • Organ procurement organizations.
  • Outpatient physical therapy/speech pathology providers.
  • Rural Health Clinics.
  • Skilled nursing facilities (SNFs).
Under Medicare Part B, Medicare providers are practitioners, health care facilities, and suppliers, including:
  • Ambulance service suppliers.
  • Ambulatory Surgical Centers (ASC).
  • Audiologists.
  • Certified diabetes educators.
  • Certified nurse midwives.
  • Certified registered nurse anesthetists.
  • Clinic/group practices.
  • Clinical nurse specialists.
  • Clinical psychologists.
  • Clinical social workers.
  • Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers (including pharmacies).
  • HHAs (outpatient Part B services).
  • Hospitals (outpatient services).
  • Independent clinical laboratories and diagnostic testing facilities.
  • Intensive cardiac rehabilitation centers.
  • Mammography centers.
  • Nurse practitioners.
  • Occupational therapists in private practice.
  • Outpatient physical therapists.
  • Outpatient speech-language pathology suppliers.
  • Physical therapists in private practice.
  • Physicians.
  • Physician assistants.
  • Portable x-ray suppliers.
  • Radiation therapy centers.
  • Registered dietitians.
  • SNFs (outpatient services).