Medical care is necessary to prevent diseases and improve quality of life. With many doctors...
As we get further into the new year, many practitioners are addressing aspects of their practice management that they feel could use expanded upon.
For many providers, this means making sure they’ve crossed all the t’s and dotted all the i’s when it comes to Medicare Provider Enrollment.
Since there are so many highly specific requirements for Medicare Enrollment, today we’ll be breaking it down to help you understand what steps you need to take to complete the task!
In order to be eligible for Medicare payment, there are forms that must be submitted that will enroll physicians to be available to receive the documentation necessary for eligibility.
Those forms are:
In order to apply for enrollment or provide updates to their current application, providers have two options:
For additional information regarding the Medicare enrollment process, including Internet-based PECOS, go to http://www.cms.hhs.gov/MedicareProviderSupEnroll
In order to report changes, providers must submit a new application to reinitiate the approval process. Providers must report changes in ownership or control, changes in practice location, or final adverse action within 30 days of the change.
Any other changes that need to be made must be reported within 90 days of the reported event.
Participation in reference to Medicare Enrollment means continued agreement to always accept assignment of claims for services provided to Medicare beneficiaries.
Additionally, agreeing to accept assignment of claims means that you are also agreeing to always accept Medicare-allowed payments in full and to not collect more from the beneficiary.
Unlike with private insurance, through the Social Security Act, you are required to submit claims for Medicare whether you participate or not.
If you do decide to participate in the Medicare program, you must also submit a participation agreement - the Medicare Participating Physician or Supplier Agreement (Form CMS-460).
Typically, this form would be submitted concurrently with the enrollment form, but can be submitted within 90 days. Benefits will not begin until the form is submitted.
Benefits of Medicare Enrollment include:
For more information on the Medicare Enrollment process, visit http://www.cms.hhs.gov/MedicareProviderSupEnroll to access the internet-based forms or to download the paper versions.
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