CMS Rules on Medicare Enrollment Process

Event Information
Product Format
Prerecorded Event
60 Minutes
Product Description

Understand Medicare Enrollment & Validation Process Correctly – To Avoid Delays In Claims Payment,  Or Even Possible False Claims Liability!

Physicians and practices that do not enroll or maintain their Medicare enrollment risk unnecessary delays in claims payment, cancellation of billing privileges, or even possible false claims liability. The whole process is complex and tricky, with lots of reporting requirements for issues that might otherwise seem insignificant. Here are different Medicare provider enrollment application forms:

Form CMS-855I: It is the most commonly used of the application forms. This 22-page form for individual practitioners cannot be processed without first obtaining an NPI number (National Provider Identifier) for which application instructions will be provided.

Form CMS-855B: For group practices and suppliers (with exception to certain DME suppliers) to enroll in or change current Medicare enrollment information.

Learn significant Form CMS-855I and Form CMS-855B information and tips from our expert presenter, Mark Kander. Avoid confusion regarding types of updated information accepted on the 855i and 855B for those who are already enrolled. 

This session will give you a rundown on reasons for avoiding hard copy submission, links to electronic submission, rules that allow applicants to determine when individual practice applications are required in addition to group applications (CMS-855B).  Rules that allow absence of Medicare enrollment and Medicare claims even though your services are rendered to Medicare beneficiaries and payment is collected from the patient directly.

This session will help you:

  • Learn why you should avoid hard-copy submission of the application
  • Discover ways to find contact information for the regional application processors
  • Learn provider settings in which Medicare enrollment is not necessary and bills  are submitted directly to the patient
  • Know when you may be required to submit two similar applications
  • Get familiar with the circumstances under which separate validation of your enrollment is required
  • Learn how multiple versions of a single form allows you to work in different group practice settings
  • NPI number: National Provider Identifier
  • MAC: Medicare Administrative Contractors (regional)
  • Standard Rules in 2013 for All Applications
  • Participating vs. Non-participating status
  • Form CMS-855i: application for individuals
  • Form CMS-855R: Reassignment of Benefits
  • Form CMS-855B: application for group practices
  • PECOS – online enrollment system
  • Form CMS-855o: if only order or refer services
  • Form CMS-855s: for dealers/suppliers of equipment & supplies
  • Validation of enrollment – initiated by your MAC
  • Medicare patients without being an enrolled provider.
  • Opting-out of Medicare: 2-year agreements w/patients
  • Treating Medicare patients without being enrolled.
  • A note regarding MAC staffers
  • And much more....

Who should attend? Any physician or other  practitioner  who wishes to submit claims to Medicare.  In addition to physician specialties, this includes audiologists, certified nurse midwives, clinical nurse specialists, physician assistants, nurse practitioners, clinical social workers, occupational therapists, physical therapists, speech-language pathologists, clinical psychologists, and registered dieticians.

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About Our Speaker

Mark Kander - Healthcare Billing Expert

Mark Kander, MHA, has been the director of Medicare and Medicaid and then director of health care regulatory analysis since 1990 in the Government Relations and Public Policy Division of the American Speech-Language-Hearing Association (ASHA). ASHA is a professional association representing audiologists and speech-language pathologists.

assists members with a wide variety of problems encountered in the Medicare and Medicaid claims process and reviews and comments on draft...   More Info
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