Medicare Provider Enrollment

The Medicare provider and supplier enrollment process is a continuous, ever-evolving process in which the provider community must focus their attention, lest you be impacted by an interruption in reimbursement.

Here are just a couple of the more recent issues addressed by CMS for your reference:

Revised CMS-588:  Electronic Funds Transfer (EFT) authorization agreement

Providers and suppliers must use the revised CMS-588 form beginning January 1, 2018. The revised form will be posted on the CMS forms list (https://go.usa.gov/xX3Sa ) by early summer. Medicare administrative contractors will accept both the current and revised versions of the CMS-588 through December 31, 2017.

A few of the changes to the revised form include:

• New indicator shows if the EFT is for an individual or a group/organization/corporation in parts 1 and 2 (reason for submission and account holder information)
• Now optional to list the financial institution’s contact person
• Four digits added to the “Provider’s/Supplier’s/Indirect Payment Procedure Entity’s Account Number with Financial Institution,” making it consistent with the industry standard

Part D Prescriber Enrollment – Effective date is January 1, 2019

In May 2014, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that revised the Medicare Advantage (MA) and Part D prescription drug benefit programs regulations. This regulation requires that all physicians and other eligible professionals who write prescriptions for covered Part D drugs are accurately enrolled in the Medicare program. This requirement will help CMS ensure that Part D drugs are only prescribed by qualified individuals.

To meet these requirements, any physician or other eligible professional (e.g., general dentists) who prescribes Part D drugs must either enroll in or opt-out of the Medicare program. Effective January 1, 2019, if prescribing physicians and non-physician practitioners have not enrolled or opted out of the Medicare Program, Medicare Part D plans will deny pharmacy claims at the point of sale. To allow time for application processing and ensure all requirements are met before the January 1, 2019 enforcement date, all prescribers should submit enrollment applications or opt-out affidavits now.

 

Prescribers enrolling to bill the Medicare program: 

If you wish to enroll in the Medicare program to be reimbursed for covered services furnished to Medicare beneficiaries, in addition to prescribing Part D covered drugs, you must complete the CMS-855I application, using either PECOS or the most recent paper form.

 

Prescribers enrolling that will not bill the Medicare program:

The CMS-855O, which is a shorter, abbreviated form, should be completed if you are seeking to enroll solely to prescribe Part D drugs. This enrollment allows prescribers to verify their personal information and credentials for the sole purpose of prescribing.  Again, note that prescribers who complete the CMS-855O will not have billing capabilities in the Medicare program.

Regarding the CMS-855O, there have been enhancements made to PECOS, providing Part D prescribers with a simplified and easy-to-use enrollment workflow to submit an 855O application, known as Easy Enrollment. Easy Enrollment streamlines the provider application process with the goal of increasing Part D enrollments in Medicare.  In addition, PECOS has added the physician specialty code C6-Hospitalist for 855I and 855O enrollments.

Note: If you do not see your specialty listed on the CMS-855O application, select the Undefined Physician Type option and identify your specialty in the space provided (e.g., general dentistry).

 

Prescribers opting out of the Medicare program:

If you elect to opt-out of Medicare, you must submit an opt-out affidavit. Your opt-out information must be current and a National Provider Identifier (NPI) is required to be submitted on the affidavit. A provider with an opt-out status may still order/refer and prescribe for Medicare beneficiaries, but may not bill the Medicare program. Providers with opt-out statuses enter into private contracts with beneficiaries.

 

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Lutz Offers Healthcare Provider Enrollment Services

Lutz provides enrollment services for healthcare providers from small physician offices up to multi-campus healthcare systems and everything in-between.   Let Lutz guide you through the process and remove the burden from you and your staff.  Services include initial enrollments, revalidations, changes of information, reassignments, state applications and revalidations, and licensure services.

The Lutz enrollment team is headed by Kirk Delperdang, who has more than 24 years of professional experience in the healthcare industry.  His expertise is in Medicare reimbursement and Medicare compliance, including provider enrollment and licensure.