Other proposed changes to government regulations included rolling back a mandate that all hospitals have a director for outpatient services. CMS would remove the requirement and allow hospitals to decide if a director is needed, said CMS Administrator Donald M. Berwick, MD. Revisions also would remove outdated technical requirements for e-prescribing so they reflect current standards.
Video: Submitting Your Medicare Enrollment Application
Medicare Delays Provider Enrollment Revalidation Until 2015
The Centers for Medicaid & Medicare Services (CMS) has delayed the requirement that physicians revalidate their Medicare enrollment under the program integrity screening provisions of the Affordable Care Act. According to CMS, the revalidation effort, originally scheduled for March 23, 2013, will be pushed back through 2015. Physicians will be among the last to revalidate.
CMS Requires Provider Revalidation
These revalidation requests began in September with an initial mailing of approximately 89,000 letters sent to providers. Nationally, there will be approximately 1.5 million letters sent to providers over the next year. These letters are being mailed to listed provider remittance addresses, correspondence addresses or location addresses, so it’s possible that your facility will receive more than one letter. No action is required until you receive a written request from Palmetto or your FI/MAC. You are required to respond within 60 days of the date of the letter.
Ability Chicago Info Blog: Physicians must revalidate Medicare enrollment by 2013 : article Aug 2011
Doctors are concerned that enrollment problems could lead some in good standing to get kicked out of the program Washington — Roughly 750,000 physicians in the Medicare program soon will be asked to revalidate their individual enrollment records during a massive anti-fraud effort required by the health system reform law. The Centers for Medicare & Medicaid Services hopes to weed out only the people who shouldn’t have billing privileges, but physicians are concerned that legitimate health professionals could get caught up in the enrollment sweep by mistake. CMS gradually will send revalidation requests by mail to more than 1.4 million health professionals — more than half of whom are doctors — between now and March 23, 2013, the agency announced on Aug. 10. Physicians who have enrolled since March 25, 2011, will not be required to revalidate, because their applications were scrutinized under new screening criteria, CMS said. Those receiving a request would have 60 days to recertify their enrollment information, which for some doctors will be similar to the process they first used to sign up with the program. “Failure to submit the enrollment forms as requested may result in the deactivation of your Medicare billing privileges,” CMS stated in the notice. Previous revalidation efforts have targeted much smaller segments of physicians, such as those who had not updated their enrollment within the past five years or medical suppliers in areas known to be at high risk for fraud. Medicare administrative contractors across the country process about 27,000 new enrollments and more than 30,000 reassignments, or changes to billing and payment information, each month. Doctors have described Medicare enrollment as tedious and confusing at times. Attempts to strengthen safeguards in the process have created problems for those caring for Medicare patients in recent years. In March, CMS implemented additional program integrity defenses mandated by the health reform law to prevent fraud. Physician practices have reported long wait times for new applications to be approved since then. “We have very significant concerns with this revalidation effort in light of the problems physicians have had with enrollment and revalidation efforts in the past,” said American Medical Association President Peter W. Carmel, MD. “The AMA is making this a priority and urging CMS to reconsider this action.” Physician practice administrators are being told to watch for the letters requesting revalidation, said Allison Brown, a senior advocacy adviser with the Medical Group Management Assn. in Washington. Practices are urged to begin revalidation as soon as they receive a request, she said. Physicians can revalidate using paper applications or by using CMS’ online enrollment system, called PECOS, the Provider Enrollment, Chain and Ownership System, which CMS says is the most efficient way to submit necessary information. But even if every practice complies with the letters as soon as they receive them, the plans to revalidate all health professionals who enrolled before March 25 would require contractors to process thousands of additional applications a day on top of the ones they already receive. Practices also must wait until their Medicare contractor sends them a request before they can revalidate. “We may end up with enrollment backlogs just given the scope of the revalidation effort,” Brown said. Bureaucratic brick walls The Neurology Medical Group of Diablo Valley in Pleasant Hill, Calif., saw the hassles of the Medicare enrollment process when it attempted to change the practice address for a neurologist who was starting at the medical group in September 2009. The initial enrollment application sent in August 2009 went missing. A second application was denied on a technicality, and a third application was approved in February 2010. But the Medicare contractor would backdate the physician’s enrollment status only to late November 2009. The contractor has denied the practice $30,000 in Medicare charges billed by the neurologist between September and November of 2009. “It was insufferably delayed, so we could not serve Medicare patients,” said Steven Holtz, MD, a neurologist at the group. The practice recently hired another neurologist, who will start on Sept. 1. The practice sent the physician’s Medicare enrollment application in July, but the contractor returned the application and noted that it was sent too early, said Nadia George, the practice administrator. Resending it on Aug. 1 resulted in an approval two weeks later, but that was short-lived. “The next day I received an email that said [the application] was rejected,” she said. She followed up with a phone call to the contractor’s enrollment department and was told the application appeared to be approved. George is planning to have the new hire treat one Medicare patient before Sept. 1 and have him submit a claim to ensure that the physician is in the Medicare system. Such an experience is not unique. Physicians tend to find enrolling in the Medicare program an unnecessarily long, complicated and bureaucratic process, said Donald Waters, executive director of the Alameda-Contra Costa (Calif.) Medical Assn. It’s a task often left to professional credentialing staff and practice administrators. But even the most experienced staffers encounter problems with confusing language on enrollment forms and vague instructions that cost physician practices time and money, Waters said. The MGMA’s Brown said CMS has planned improvements to the enrollment website. Changes would allow physicians to sign online applications electronically, instead of having to print a certification statement for the application and mail it to a contractor. The improvements could be implemented by January 2012, she said. # Source: American Medical Association By Charles Fiegl, amednews staff, Aug 29, 2011 http://www.ama-assn.org/amednews/2011/08/29/gvl10829.htm
Revised Medicare Provider
Medicare Provider-Supplier Enrollment Applications (CMS-855). While the revised forms may be used immediately, the previous 2008 versions may be used through October 2011. In addition, CMS has released a new CMS-855O application form to be used for the sole purpose of enrolling to order and refer items and/or services to Medicare beneficiaries; this form must be used immediately.
Medicare Provider Enrollment Revalidation
Providers and suppliers should submit revalidation only after receiving the request from their MAC to do so. Providers and suppliers will have 60 days from the date of the letter to submit the required completed enrollment forms. Failure to submit enrollment forms as requested may result in the deactivation of Medicare billing privileges. Revalidation can be completed through the Internet-based Provider Enrollment Chain and Ownership System (PECOS) or a paper application; currently, federally qualified health centers only may submit paper enrollment applications. Please note: CMS forms 855A, 855B, 855I, 855O, 855R and 855S all have been revised as of July 1, 2011, and should be used for the provider enrollment revalidation. The new forms can be found by searching “855” on the CMS website.
Providers and Suppliers Must Keep Their Medicare Enrollment Information Current on ADVANCE for Respiratory Care and Sleep Medicine
Obviously, Medicare providers and suppliers need to know what enrollment information must be updated and the time in which the information must be updated. CMS regulations require Medicare providers and suppliers to update their enrollment information within 30 days of any adverse legal action, any change in ownership, any change in location, or any change in general supervision. Medicare providers and suppliers are required to notify the Medicare carrier or contractor of any other changes in their enrollment information within 90 days of the change. However, durable medical equipment, prosthetics, and orthotics suppliers are required to report all changes in their enrollment information to the National Supplier Clearinghouse within 30 days.
Honoring the 13th Amendment: Physician Rights, Medicare & You
Ambiguity arises because Medicare laws uses variants of ―participate‖ in two very different ways: 1. Sec. 1866. [42 U.S.C. 1395cc] (a)(1) 14 defines a physician as ―qualified to participate‖ in Medicare and ―eligible for payments‖ if he or she voluntarily chooses to file ―with the Secretary an agreement…‖ This is the fundamental ―Enrollment Process.‖ Sec. 1848. [42 U.S.C. 1395w–4] (g)(4)(A)15 ―Physician Submission of Claims‖ can only apply to an enrolled physician (―qualified to participate‖ under Sec. 1866. [42 U.S.C. 12 Sec. 1842. [42 U.S.C. 1395u] (b)(6)(A) ―The term ―participating physician‖ refers … to a physician who at the time of furnishing the services is a participating physician (under subsection (h)(1)); the term ―nonparticipating physician‖ refers, with respect to the furnishing of services, to a physician who … is not a participating physician … (as defined in subsection (h)(1)).‖ ―(h)(1) Any physician … may voluntarily enter into an agreement with the Secretary to become a participating physician …. For purposes of this section, the term ―participating physician or supplier‖ means a physician … who … enters into an agreement with the Secretary which provides that such physician … will accept payment under this part on an assignment-related basis for all items and services furnished to individuals enrolled under this part during such year.‖ (Emphasis added) 13 Sec. 1848. [42 U.S.C. 1395w–4] (g)(1)(A) ―Limitation of actual charge.—In the case of a nonparticipating physician … or other person (as defined in section 1842(i)(2)) who does not accept payment on an assignment-related basis for a physician’s service furnished with respect to an individual enrolled under this part, the following rules apply: (i) Application of limiting charge.—No person may bill or collect an actual charge for the service in excess of the limiting charge described in paragraph (2) for such service. (ii) No liability for excess charges.—No person is liable for payment of any amounts billed for the service in excess of such limiting charge.‖ (Emphasis added) 14 Sec. 1866. [42 U.S.C. 1395cc] (a)(1) AGREEMENTS WITH PROVIDERS OF SERVICES; ENROLLMENT PROCESSES ―(1) Any provider of services (except a fund designated for purposes of section 1395f (g) and section 1395n (e) of this title) shall be qualified to participate under this subchapter (Medicare) and shall be eligible for payments under this subchapter if it files with the Secretary an agreement…‖ (Emphasis added) 1395cc] (a)(1)) who is eligible to ―submit a claim for such service on a standard claim form specified by the Secretary to the carrier on behalf of a beneficiary…‖ 2. Sec. 1842. [42 U.S.C. 1395u] (h)(1) defines a “participating” physician as one who agrees to accept payment from Medicare on an assignment-related basis for all items and services. Although Sec. 1842 is silent on the prerequisite enrollment requirement, Sec. 1866 makes it clear that only a physician who chooses to file ―with the Secretary an agreement…‖ is ―qualified to participate‖ in Medicare and is ―eligible for payments‖ from Medicare. Although still silent on the prerequisite enrollment requirement, Sec. 1842 further defines a “non-participating” physician as one who does not agree to accept payment on an assignment-related basis for all claims paid by Medicare. Sec. 1842’s specific definition of ―non-participating‖ is confusing, and some may apply it erroneously to describe a physician who does not enroll in Medicare and thus is not obligated to Medicare at all. Sec. 1848(g)(1)(A) ―Limitation of Actual Charges‖ can also only apply to an enrolled physician “qualified to participate‖ under Sec. 1866. [42 U.S.C. 1395cc] (a)(1) who must ―submit a claim to the carrier” but is “non-participating” under Sec. 1842. [42 U.S.C. 1395u] (h)(1). Before the issue of ―participating‖ or ―non-participating‖ is reached a physician must have already voluntarily enrolled. Medicare acknowledges that ―mandatory claim submission provisions of Sec. 1848(g)(4) apply to a physician who ―must submit a claim to Medicare‖ and ―must be enrolled in the Medicare program‖16 but may sometimes overlook the choice that physicians have to either enroll or not enroll in the program.
Are You Submitting a Handwritten Medicare Enrollment Application?
Medicare enrollment application forms are fillable on your computer. This means that you can fill out the information required by typing into the open fields while the form is displayed on your computer monitor. Filling out the forms this way before printing, signing and mailing means more easily-readable information – which means fewer mistakes, questions, and delays when your application is processed. Be sure to make a copy of the signed form for your records before mailing.
Medicare looks to ease doctor revocation rules
Other proposed changes to government regulations included rolling back a mandate that all hospitals have a director for out-patient services. CMS would remove the requirement and grant hospitals to decide if a director is needed, stated CMS Administrator Donald M. Berwick, MD. Revisions also would remove outdated technical requirements for e-prescribing so they reflect current standards.
Revised 855S Enrollment Application
After October 31, 2011, DMEPOS suppliers will no longer be permitted to use the 07/09 version of the CMS-855S application and will be required to utilize the updated 07/11 version. The 07/11 version is available and may be used for submissions now. The newest version of the application has been updated to capture additional information pertinent to processing by the National Supplier Clearinghouse. If a supplier submits the 07/09 version after October 31, 2011, the application will not be processed and it will be returned to the supplier.
CMS Posts Medicare Learning Network Enrollment Fact Sheet to Help Educate Ordering Physicians
The Centers for Medicare & Medicaid Services has issued new educational materials for physicians and other ordering and referring practitioners. This fact sheet provides education on the enrollment requirements for eligible ordering/referring providers. In the fact sheet CMS spells out who the requirements apply to as follows:
Medicare Providers Must Begin to Revalidate Enrollment By March 2013
Between now and March 2013, MACs will be sending notices to individual providers/suppliers; please begin the revalidation process as soon as you hear from your MAC. Upon receipt of the revalidation request, providers and suppliers have 60 days from the date of the letter to submit complete enrollment forms. Failure to submit the enrollment forms as requested may result in the deactivation of your Medicare billing privileges. The easiest and quickest way to revalidate your enrollment information is by using Internet-based PECOS (Provider Enrollment, Chain, and Ownership System), at https://pecos.CMS.hhs.gov.
Medicare beneficiaries on a Medicare Supplement plan who wish to change their Medicare Part D coverage in 2012 do so during the AEP. / eHealth
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SLP and Audiology Medicare Providers Must Revalidate Enrollment
All speech-language pathologists (SLPs) and audiologists who enrolled in Medicare prior to Friday, March 23, 2011, will need to revalidate their enrollment at some point between now and March 2013. This is due to new risk screening criteria required under the Affordable Care Act (ACA) which was implemented by the Centers for Medicare and Medicaid Services (CMS) in March 2011. The new risk screening criteria places providers and suppliers in one of three screening categories – limited, moderate, or high. These categories represent the level of risk to the Medicare program and determine the degree of screening that will be done by the Medicare Administrative Contractor (MAC) processing the enrollment application that will be submitted for revalidation. SLPs and audiologists enrolled as individuals or group practices are placed in the limited category. The enrollment process for providers and suppliers in the limited category remains unchanged.