Medicare Provider Enrollment involves submitting the appropriate Medicare Provider/Supplier application forms such as the 855I, 855B, 855S, 855O, and 855A; or utilizing the Medicare Provider Enrollment, Chain, and Ownership System (PECOS). PECOS is an online enrollment system that allows you to make application or changes to your enrollment record. Medicare Enrollment requirements are very strict and each state intermediary adheres to a strict standard of compliance for processing enrollment applications.
- CMS 855I - Individual Application
- CMS 855B - Group Application
- CMS 855R - Reassignment of Benefits
- PECOS
The CMS-855I is the paper application for Physicians and Non-Physician Practitioners. This application is for initial enrollment in the Medicare program or changes to your existing Medicare record. The application is 27 pages and is processed by the Medicare Administrative Contractor (MAC) responsible for managing the jurisdiction in which you are applying. There are 12 different MACs managing CMS programs across the country. It is important that your application be submitted to the MAC responsible for your state.
The CMS-855B application is for Clinics/Group Practices and certain other providers. This application is to enroll your business entity with Medicare so that payment for rending provider services can be paid to the business entity. For medical groups, this application is required if the entity is owned by more than one person or by a person other than a provider enrolling under the entity. If a solo practitioner is the sole owner of a business entity, then this application is not required. In the case of solely owned business entities, you can complete your entity enrollment application on the individual application 855I.
In order for a group application to be processed, there must also be at least one provider enrolling for re-assignment to the group. You cannot simply enroll a medical practice without having providers to treat Medicare beneficiaries.
This paper form is used to re-assign a providers Medicare benefits to an organization. After forming a business entity and enrolling the business entity with Medicare, your employed providers can re-assign payments for services rendered to your organization so that all payments are made to your practice under the single tax id. Providers can have multiple re-assignments active at anytime for multiple employers. In order to re-assign benefits a provider must first have an individual enrollment record (CMS855I) and the organization must have an enrollment record (CMS855B).
If a provider is changing employers within a Medicare jurisdiction, you may only need to file an 855R to re-assign your benefits to your new employer. You will also need to terminate your re-assignment with the previous employer.
PECOS is the online enrollment system for CMS. Providers may utilize PECOS to submit initial enrollment applications or to make changes to existing enrollment records. PECOS allows for electronic signature of applications making the process more efficient. There are some pitfalls to utilizing PECOS however. Some of the MACs are not efficient at downloading and updating PECOS with submitted applications. There are many situations of lost data or incorrect import of information from PECOS to the MAC application processor. It is therefore very important to know the details of your application submission and follow up on a regular basis to ensure your PECOS application is handled correctly.
Common Application Mistakes Causing Rejection or Delays
Signatures
Sign your applications with blue ink and be certain that each signature is dated
Supporting Documents
Ensure all required supporting documents are submitted with your application
Legal Business Name
Be certain that your legal business name is exactly as shown on file with the IRS for business entities or exactly as shown on file with the Social Security Administration for sole proprietors.
EFT Information
Incomplete or incorrect information on the form CMS588 to establish Electronic Funds Transfer for Medicare payments. Leaving any section of this form blank will cause delay in your application
Submission of Group Application Without Providers
You cannot enroll your business entity without service providers re-assigned to the entity. An 855B application submitted without at least one provider 855R application will be rejected.
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