LUTZ BUSINESS INSIGHTS

 

provider enrollment updates

kirk delperdang, healthcare manager

 

Medicare Provider Enrollment

The Medicare provider and supplier enrollment process is a continuous one which requires on-going attention, lest you be impacted by an interruption in reimbursement. 

Here are just a couple of the more popular items that providers find themselves contending with regarding their Medicare enrollments:

Changes of Information

Changes of information to your CMS-855 enrollments should be submitted if you are changing, adding, or deleting information under your current tax identification number.  The CMS Provider Integrity Manual or PIM Chapter 15 is the guide to follow when you have questions regarding requirements for your Medicare enrollment.  Additionally, specifically for changes of information, in accordance with 42 C.F.R. 424.516(e), unless otherwise noted below, changes in your existing enrollment data must be reported to CMS within 90 days of the effective date of the change.

Information changes to be reported include (but are not limited to):

  • Legal business name or doing business as (dba) name
  • Change of ownership – all sections must be submitted and must be reported within 30 days of the effective date of the change 
  • Adverse history – must be reported within 30 days of the effective date 
  • Main practice location change, to add an additional location or to delete a location – must be reported within 30 days of the effective date 
  • Ownership interest or managing control information 
  • Billing agency information 
  • Authorized or delegated officials

Revalidations

If you have spent any time in Medicare enrollment over the last decade, you know what revalidations are and the pitfalls that can befall you if you are not prepared.  CMS began the second round of revalidations in 2016 and will continue this process through the completion of Round 2.

In an effort to help providers/suppliers in this second round of revalidations, CMS has provided multiple resources for your reference purposes.  A few of these can be found via these references.

Revalidation Resources1

Other assistance provided by CMS includes:

  • End-of-month due dates
  • The ability to  revalidate an enrollment up to 6 months before it is due
  • Early notifications via the PECOS Revalidation Notification Center

How should I submit my Medicare enrollment records? 

The best way to submit Medicare enrollment information, whether it be an initial enrollment, change of information, reassignment, or other, is via the PECOS system.  WHY??  – Since we assume time and money are important to you in operating your practice or facility, those are two great reasons to use PECOS.  Here are some more reasons:

  • Electronic submission is faster than paper (Who knew?)  (45 days vs 60 days, on average)
  • PECOS drives the correct pages and sections to complete, instead of you having to guess what sections and pages to complete
  • Better accuracy
  • Easier to check status
  • Ability to upload supporting documentation
  • Pay enrollment fees
  • Reduction in chances of development – Again, less time and money

Where will I likely do wrong?

So, we just told you that you should submit your Medicare enrollment items via PECOS instead of paper.  This does not mean that PECOS is perfect or that it prevents all errors.  Here are some likely cases where you may stub your toe in the PECOS submission process:

  • Faulty submission – make sure you receive a submission receipt 
  • Not uploading the appropriate signed and dated certification statement timely
  • Failure to submit the required documentation (e.g. CP-575, Licenses, CMS-588, Other) 
  • Attaching a paper copy of the enrollment to the electronic copy of the enrollment

OK  –  With all of these tools at your disposal, as well as the Lutz enrollment team, you should be able to keep your Medicare enrollment in good standing with CMS.  We don’t want any preventable enrollment issue to negatively impact your reimbursement.

 

1 – As provided on the WPS GHA Provider Enrollment website

ABOUT THE AUTHOR

402.496.8800

kdelperdang@lutz.us

LINKEDIN

KIRK DELPERDANG + HEALTHCARE MANAGER

Kirk Delperdang is a Healthcare Manager at Lutz with over 25 years of experience. He provides accounting and consulting services to healthcare and related organizations.

AREAS OF FOCUS
AFFILIATIONS AND CREDENTIALS
  • Healthcare Financial Management Association - Nebraska Chapter, Member
  • Nebraska Society of Certified Public Accountants, Member
EDUCATIONAL BACKGROUND
  • BA in Accounting, University of Northern Iowa, Cedar Falls, IA
COMMUNITY SERVICE
  • St. Vincent de Paul, Knights of Columbus, Member
  • Active in various youth sports leagues: Aldrich Elementary, Millard Athletic Association, Millard North Schools, Omaha FC, Skutt Catholic High School and YMCA

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