Medicare enrollment involves selecting the correct enrollment forms from CMS and completing the forms with 100% accuracy. Here are the forms that you will need:
CMS855I; this is the individual provider enrollment application. This form captures all the details of an individual provider as well as information about where he/she provides services to patients. Not every section of the enrollment form applies to all providers, so you will need to closely read each page to determine what needs to be completed for your enrollment.
CMS855R; re-assignment of Medicare benefits. This form captures information about the provider and the business entity to which all payments will be made for the providers services. In other words, this form filing is what allows your business entity under its tax id# to receive payments in the entity name for the services provided by a physician.
CMS855B; this is the Clinic / Group Practice enrollment application. This form captures all the details of your business entity under which you provide services. As in the case of the 855I, not all sections are going to apply to every applicant. So, it is important to fully read the application and follow instructions for your type of entity.
CMS460; this form elects participation in the Medicare program. When filing your Medicare enrollment application, you may elect participation or non-participation status. It is important that you submit this form for each individual provider as well as one for your business entity, using the type 2 NPI, if you want to elect participation. For more information on par vs non-par, see our blog post about the subject.
CMS588; electronic funds transfer authorization agreement. Medicare will only submit payments via EFT. Therefore this is a required form with your enrollment package. The CMS588 must be accompanied with proof of your bank account in the form of a pre-printed voided check or letter of verification from your bank. It is important to note that the pre-printed check or bank letter of verification must match your legal business name exactly as it is on file with the IRS and as is shown on your CP575. If the name is different, including suffixes such as LLC, Inc, etc, your EFT application will be rejected.
Now that we have listed the forms that you may need, let’s discuss a few scenarios to understand how the necessary forms can change.
If a physician is starting a new medical practice and the physician owns 100% of a Professional Corporation under which he/she will practice, then the physician will need to file forms 855I, CMS460, & CMS588. Since the physician owns 100% of the business entity, he/she can obtain the business entity enrollment using the 855I form and does not have to file the separate CMS855B application for the Clinic.
If two physicians are forming a partnership to open a new practice and each owns 50% of the business entity, then each physician will need to file an 855I, CMS460, & 855R; and the business entity will need to file an 855B, CMS460, and CMS588. Since there is more than one owner the separate group application must be filed.
If a physician is changing practices in a state in which he is already enrolled and the practice he is joining already has a Medicare enrollment record, then a form CMS855R must be filed to re-assign his benefits to the existing medical group.
If a physician is moving to a new state to join an existing medical group, then forms CMS855I & CMS855R will need to be filed. These forms will enroll the physician with the state intermediary and re-assign his benefits to the existing group practice. The individual provider will be assigned the same participation status as the group, so a CMS460 form only needs to be filed if the provider participation election will be different from the group record.
Medicare revalidation requires submission of the 855I application when the provider is requested to revalidation. And submission of a complete CMS855B application when the entity is required to revalidate. New EFT information may be required as part of the revalidation process.
Supporting documents that are required to be submitted with enrollment applications vary by type of supplier. MD’s and DO’s for example rarely need to submit any supporting documents. Documents that may be requested include ECFMG certificate, or citizenship documentation. Most other elements for MD’s and DO’s are verified by the primary source as part of the enrollment process.
Nurse Practitioners, on the other hand, must submit a copy of their diploma, board certification, and license.
Supporting document needs are listed on the final pages of each application. Pay close attention to the list and if you are uncertain, then contact the provider enrollment department of your Medicare carrier.
If there are any deficiencies in your enrollment application forms or supporting documents, your Medicare carrier will issue you a “development letter”. You have a defined amount of time in which to respond to their development request. If you do not provide the requested information, then your application will be returned denied. If an application is denied there is a waiting period before you can file another application. Development letters are of the highest priority and should always be responded to as quickly as possible.
Medicare enrollment can be time consuming. If you don’t submit a correct application on first submission, you will have an opportunity to correct mistakes, but the time frame for correcting the errors is short. Pay close attention to all details of each form.
For assistance with completing your Medicare enrollment applications, contact nCred to discuss how our services can help your practice.
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