Medicare Re-assignment When Crossing State Lines
CMS announced guidance on inter-jurisdictional reassignments affecting providers in one MAC jurisdiction that re-assigns benefits to an organization located in another MAC jurisdiction. The full program guidelines can be found here. Here is the text of the article:...
Medicare Provider Enrollment Eligibility Verification
Providers and suppliers enrolled in the Medicare program are required to submit a physical practice location address on the initial provider enrollment application, and are required to report any changes of address to Medicare within 30 days. Recently the GAO examined...
Medicare changes to opt-out rules
Changes to the Medicare Opt-Out Law for Physicians and Practitioners Prior to enactment of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), physician/practitioner opt-out affidavits were only effective for 2 years. As a result of changes made by...
Physician Assistant (PA) Medicare Enrollment Requirements
Enrolling a Physician Assistant with Medicare is a little different than with other eligible healthcare providers. PA's don't actually enroll directly with Medicare, but file an employment arrangement with a physician or medical organization. The enrollment form...
The Provider Enrollment Process
Provider Enrollment (or Payor Enrollment) refers to the process of applying to health insurance networks for inclusion in their provider panels. For Commercial Insurance networks, this process involves 1) Credentialing and 2) Contracting. During the first step, the...
Payor Enrollment for Nurse Practitioner’s
Health plan credentialing (Enrollment) for Nurse Practitioners can bring about some unique challenges. Providers who are operating an outpatient clinic as a primary care provider will need to be directly credentialed and contracted with health plans. Know the...
Your Clinic/Group Practice Medicare enrollment record
An important condition of maintaining your Medicare billing privileges is to ensure that your entity enrollment record is always current. Elements of your enrollment record that may change include ownership, practice location (all service locations), billing company...
2015 CMS Application Fee
CMS announced a $553.00 calendar year (CY) 2015 application fee for institutional providers that are initially enrolling in the Medicare or Medicaid program or the Children's Health Insurance Program (CHIP); revalidating their Medicare, Medicaid, or CHIP enrollment;...
BCBS GA Required to halt contract amendment
BCBS of Georgia attempted to push a contract amendment on all of its participating providers in November. However, the GA Insurance Commissioner forced BCBS to halt implementation of the amendment and require the insurance company to submit any amendments to the...
2015 Medicare deductible changes
Medicare has published changes to the premiums and deductibles for 2015. See the latest MLN article for more information. MLN article MM8982
CMS finalizes program changes for Medicare Advantage and Prescription Drug Benefit Programs for Contract Year 2015
Beginning June 1, 2015, Medicare will require all physicians and eligible providers who order Durable Medical Equipment, Prosthetics, and Supplies, or certify home health care to be enrolled with Medicare. The statute also permits the Secretary to extend these...
Online reset for I&A user IDs (used for PECOS)
CMS recently updated the process for retrieving forgotten user IDs and passwords for the Identity & Access Management (I&A) system. I&A controls access to the Medicare enrollment system PECOS, the National Plan and Provider Enumeration System (NPPES) and...
