Provider Enrollment Series-Part 2: Submitting the CMS 855I

Provider Enrollment:
“Completing the
CMS 855-I Form”
June 17, 2015
Presented by:
Cahaba GBA
Part B Provider Outreach and Education
John Florence
Disclaimer
This presentation was current at the time it was published. Medicare policies change
frequently so links to the source documents have been provided within the document
for your reference. This presentation was prepared as a service to the public and is not
intended to grant rights or impose obligations.
This presentation may contain references or links to statutes, regulations, or other
policy materials. The information provided is only intended to be a general summary.
Use of this material is voluntary. Inclusion of a link does not constitute Cahaba nor
CMS endorsement of the material. We encourage providers to review the specific
statutes, regulations, and other interpretive materials for a full and accurate
statement of their contents.
2
Acronym Listing
Acronym
Meaning
CHOI
Change of Information
CMS
Centers for Medicare and Medicaid Services
DNF
Do Not Forward
EFT
Electronic Funds Transfer
NPI
National Provider Identifier
NPPES
National Plan and Provider Enumeration System
PECOS
Provider Enrollment Chain and Ownership System
PTAN
Provider Transaction Access Number
TIN
Tax Identification Number
http://cms.gov/Outreach-and-Education/Medicare-Learning-NetworkMLN/MLNProducts/Downloads/Acronyms-Educational-Tool-ICN908999.pdf
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Agenda
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•
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•
•
•
•
•
•
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Medicare Provider Enrollment
Enrollment Options for CMS 855-I
CMS Provider Enrollment Forms
CMS 855-I Enrollment Actions
Who Should Complete CMS 855-I Application
Internet-based PECOS
Each Section of CMS 855-I Paper Application
CMS 855-I Enrollment Common Errors
CMS 855-I Enrollment Best Practices
Cahaba Updates and Enrollment Resources
4
Medicare Provider Enrollment
•
Process by which providers become authorized to bill the Medicare
program
•
Provides a means for CMS to screen providers
•
Sources of Regulations and Guidance
– Federal Register
– Medicare Internet Only Manuals (IOMs)
• Medicare Program Integrity Manual 100-08, Chapter 15 – Medicare Enrollment
http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/pim83
c15.pdf
– Technical Direction Letters (TDLs) and Change Requests (CRs)
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Enrollment Options
• Complete, sign and submit the appropriate CMS-855 form
– Download a paper Medicare enrollment application
or
• Use the Provider Enrollment, Chain and Ownership System
(PECOS) to enter information over the internet
(http://pecos.cms.hhs.gov), and mail a signed certification
– Access appropriate PECOS tutorial via CMS website
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CMS Provider Enrollment Forms
•
•
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855A — Part A Providers
855B — Part B Providers
855I — Part B Physicians and Non-Physician Practitioners
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•
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should be completed by physicians and non-physician practitioners who render
Medicare Part B services to beneficiaries. (This includes a physician or practitioner
who:
(1) is the sole owner of a professional corporation, professional association, or
(2) limited liability company, and will bill Medicare through this business entity
855R — Reassignment of Medicare Benefits
855S — DME Suppliers
855O — Ordering & Referring Physicians & Non-Physician Practitioners
588 — Electronic Funds Transfer Authorization Agreement
460 — Participating Provider Agreement
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Types of Enrollment Actions
Enrollment actions for the CMS 855-I Form:
• Initial enrollment
• Revalidation
• Reactivation
• Voluntary Termination (Individuals and Physician Assistants)
• Change of information (CHOI)
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CMS 855-I Form
Instructions
• Type or Print all information legibly
• Do not use pencil (blue ink preferred)
• Attach all supporting documentation
• Keep a copy of your completed
application for your records
• Make sure that you send the completed
application with original signatures and
all required documentation to Cahaba
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Who should complete 855-I Form
• Physician (including solo practitioners who are incorporated or not
incorporated)
•
Non-physician practitioner
Anesthesiology Assistant
Audiologist
Certified Nurse Midwife
Certified Registered Nurse
Anesthetist
– Clinical Nurse Specialist
– Clinical Social Worker
– Nurse Practitioner
–
–
–
–
– Occupational Therapist in Private
Practice
– Physical Therapist in Private Practice
– Physician Assistant
– Psychologist, Clinical
– Psychologist billing independently
– Registered Dietitian or Nutrition
Professional
– Speech Language Pathologist
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How to Enroll in Medicare
1) Obtain a National Provider Identifier
•
NPPES at https://nppes.cms.hhs.gov/NPPES/Welcome.do
2) Complete the proper Medicare Enrollment application
•
855-I Form or enroll through PECOS
3) Determine if you want to be a participating provider
•
Medicare Participating Physician Agreement (CMS 460)
4) Keep your enrollment information current
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National Provider Identifier (NPI)
• The National Provider Identifier (NPI)
is meant to be a lasting
identifier, and is expected to remain unchanged even if a health care provider
changes his or her name, address, provider taxonomy, or other information that
was furnished as part of the original NPI application process.
•
There are some situations, however, in which an NPI may change such as when he
alth care provider organizations determine they may need a new NPI
•
There also may be situations where a new NPI is necessary because the current
NPI was used for fraudulent purposes.
https://nppes.cms.hhs.gov
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NPPES
• National Plan & Provider Enumeration System (NPPES)
– Apply online to obtain a National Provider Identifier (NPI) using the National
Plan & Provider Enumeration System (NPPES). You may also update your
information on file by accessing the system
•
Access the NPI enumeration system (NPPES)
– https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.instructions
•
Search for provider NPI information using the NPI Registry
– https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do
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Internet-Based PECOS
https://pecos.cms.hhs.gov
• Providers can perform the following functions within PECOS:
– Submit new initial enrollment record
– Make changes to existing enrollment record
– Add or change reassignment of benefits
– Reactivate or revalidate enrollment
– Voluntarily withdraw enrollment
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Application Process
Cahaba’s Provider Enrollment (Analyst) follows the process of:
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Pre-Screening
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Verify and Validating
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Post-screening
•
Approving
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Possible Outcomes
• You are granted Medicare billing privileges
• You are contacted for missing information
• Your application is rejected or returned
• Your application is denied
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Pre-Screening Process
•
Once application is received, a PE analyst determines whether all
the necessary data elements and documentation is completed:
– Within 15 days of receipt of application (in most cases)
– If data elements or documents are missing, Cahaba will send a letter
that requests the information
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If everything is satisfactory with application received, the analyst
will start verification process:
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–
–
–
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Supporting documentation
NPPES
IRS data (TIN, if applicable)
Office of Inspector General (OIG)
System for Award Management (SAM)
Information from State licensing boards (if applicable)
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Application Development
When Provider Enrollment analyst needs additional information:
– Cahaba will send a letter to the provider
• The letter will list what is needed to complete the processing of
application
• Provider has 30 days to return information
• Letter identifies processor’s name and return information
• Return information via mail
– If development response is not received in time specified
• Application will be denied or rejected
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Change of Information (CHOI)
Provider Type
30-day reporting
90-day reporting
Physicians, Non-physician
practitioners, physician
organizations
Change of ownership,
adverse legal actions
(e.g., licensure
revocation),
change in practice
location
All other changes
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When to complete 855-I
New Group
• For reassigning individuals who are new to the Medicare program,
or not enrolled in PECOS (Sections 1, 2, 3, 4B, 13 and 15)
• For employed physician assistants (Sections 1, 2, 3, 13, and 15)
New Organization (no members)
• You do not have to complete the 855-I Form
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When to complete 855-I cont’d
New Sole Owner (Provider)
• Single application for both the entity and the individual sole owner
(Sections 1, 2, 3, 4A, 4C, 4E, 8, 13, 15) and
– If applicable 4D, 4G, and 6
•
•
For reassigning individuals who are new to the Medicare program, or
not enrolled in PECOS (Sections 1, 2, 3, 4B, 13 and 15)
For employed physician assistants (Sections 1, 2, 3, 13, and 15)
New Sole Owner (Non-Provider)
• For reassigning individuals who are new to the Medicare program, or
not enrolled in PECOS (Sections 1, 2, 3, 4B, 13 and 15)
• For employed physician assistants (Sections 1, 2, 3, 13, and 15)
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When to complete 855-I cont’d
New Sole Proprietor (Provider)
• For sole proprietor (Sections 1, 2, 3, 4B, 4C, 4E, 8, 13, 15)
• For reassigning individuals who are new to the Medicare program,
or not enrolled in PECOS (Sections 1, 2, 3, 4B, 13 and 15)
• For employed physician assistants (Sections 1, 2, 3, 13, and 15)
New Individual Reassigning Benefits to an Established Group
• For reassigning individuals who are new to the Medicare program,
or not enrolled in PECOS (Sections 1, 2, 3, 4B, 13 and 15)
• For employed physician assistants (Sections 1, 2, 3, 13, and 15)
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When to complete 855-I cont’d
Individual established in PECOS Reassigning Benefits to an
Established Group
• For employed physician assistants (Sections 1, 2, 3, 13, and 15)
New Enrollee in Medicare
• Complete all sections of 855-I
Enrolling with another fee-for-service contractor
• Completed all sections of 855-I
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When to complete 855-I cont’d
Revalidating Providers Applications
• Same requirements as a new enrollee
Established Providers not enrolled in PECOS
• Same requirements as a new enrollee
Reactivating your Medicare Enrollment Record
• Same requirements as a new enrollee
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How to Complete Each Section of the
CMS 855-I Form
CMS 855-I (07/11)
Section 1A: Basic Information
•
Medicare Identification Number is
often referred to as a:
– Provider Transaction Access Number
(PTAN) or
– Medicare Legacy Number
•
Select a Reason for Application
– Check one box on 855I Form
√
•
7654321
1234567890
After selecting the reason, complete:
– Billing number information
–
(if applicable) &
Required Sections (if applicable)
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Section 1B: Basic Information (cont’d)
•
•
Check all of the boxes that apply
After selection has been made:
– Complete the required sections
– For each box selected
√
√
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Section 2A-B: Identifying Information
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2A: Personal Information
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–
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License Information,
Certification Information,
New Patient Status Information
2B: Correspondence Address
Provide contact information for person
in Section 2A
– Cannot be a billing agency’s address
–
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Section 2C-2D1: Identifying Information (cont’d)
•
Section 2C:
– Complete Section 2C
(if applicable)
– If not applicable:
• Skip this Section &
• Go to 2D
•
Section 2D:
– Designate your primary
specialty (P) {only 1} and,
– All secondary specialties (S)
{can be multiple secondary}
√
– Physician must meet all
Federal & State requirements
P
√
S
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Section 2D2: Identifying Information (cont’d)
•
Section 2D.2 Non-Physician
– If you are non-physician
practitioner, check the appropriate
box to indicate your specialty
• Must meet specific licensing
• Educational, &
• Work experience requirements
•
√
Check only one of the following
listed to the left:
– If you want to enroll as more than 1,
– You must submit a separate CMS
855I Form for each non-physician
specialty
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Section 2E-G: Identifying Information (cont’d)
•
Section 2E
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•
Section 2F
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•
Establishing Employment Arrangements
• Employer’s name, effective date of
employment, employer MIN, employer NPI,
employer’s EIN
Terminating Employment Arrangements
• Same as requirements listed for 2E
Section 2G
–
Establishing Employment Arrangements
• Same requirements listed for 2E, minus
– The effective date of employment but of
departure
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Section 2H-K: Identifying Information (cont’d)
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Section 2H
For Clinical Psychologists
If yes, furnish field of your psychology
degree
– Attach a copy of degree
–
–
•
Section 2I
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–
•
Section 2J
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–
–
•
Psychologists billing independently only
Answer 4 questions (Yes/No)
PT and OT in Private Practice
Answer 4 questions (Yes/No)
If “Yes” for 2-5, copy of lease is needed
Section 2K
–
If yes, supply SNF name and address
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Section 2L: Identifying Information (cont’d)
•
√
Section 2L:
– This section must be completed by
all individual practitioners that
furnish/bill Medicare for
ADI services
– All must be accredited in each
modality checked to the left to
qualify to bill Medicare for services:
•
•
•
•
Magnetic Resonance Imaging (MRI)
Computed Tomography (CT)
Nuclear Medicine (NM)
Positron Emission Tomography (PET)
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Section 3: Final Adverse Legal Actions
•
•
Final adverse legal actions must be
reported
Convictions
– Provider/supplier or any owner
within the last 10 years
– Misdemeanors or felony
•
•
Exclusions, revocations, or suspensions
Licensure suspension or revocation
– e.g., state licensing authority
•
Payment suspension under Medicare
billing number
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Section 3: Final Adverse Legal (cont’d)
•
Section 3
– Final Adverse Legal History
• If “Yes”, continue section
• If “No”, skip this section
√
–
If “Yes”, section consists of:
•
•
•
•
•
•
Report each final adverse legal action,
When it occurred,
Federal/State agency,
Court/Administrative body,
Resolution (if any),
Attach copy of documentation and
resolution
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Section 4A-4C: Practice Location
•
Section 4A:
For establishing a Professional Corporation,
Professional Association, Limited Liability
Company, etc.
– If you meet the above-mentioned, complete this
Section 4A
• Skip to Section 4C, and complete remainder of
application
–
Willie B Muschamp
310000000
7654321
1234567890
√
√
√
√
•
Section 4B:
–
•
Individual affiliations (private practice & group affiliations)
Section 4C:
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Practice Location Information
• If you completed Section 4A, complete 4C thru 17
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Section 4C: Practice Location (cont’d)
•
√
02/01/2015
•
•
Willie B Muschamp
100 Main Street
–
–
Suite 123
Auburn
(334) 123-4567
7654321
√
02/01/2015
Complete if you or your organization see
patients for more than one location
Copy and complete Section 4C for each
location
If you’re changing, adding, or deleting
information, check the applicable box
AL
(334) 220-2100
Furnish effective date,
Complete appropriate fields in section
36830-3346
[email protected]
1234567890
•
If you’re enrolling for the first time, or if
you are adding a new practice location,
Note:
the date you provide should be the date
1st Medicare patient was seen at location
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Section 4D: Practice Location (cont’d)
Section 4D
•
Rendering Services in Patients’ Homes
– List City/Town, State, and Zip Code for all
locations
• Check one to indicate if it is a:
–
–
–
–
Change
Addition
Deletion
Date (mm/dd/yyyy)
•
Initial Reporting and/or Additions
– City/Town, State, Zip Code
•
Deletions
– City/Town, State, Zip Code
38
Section 4E-4F: Practice Location (cont’d)
•
Section 4E: Remittance or Special Payments?
–
√
Check one to indicate:
–
–
–
–
02/01/2015
√
Change
Addition
Deletion
Enter date (mm/dd/yyyy)
– Indicate if “Special Payments” address
– is the same as practice location or,
– Different than the one in Section 4C
– Be Sure to provide Address, City/Town, State,
Zip Code
PO Box 12345
Auburn
AL
36830-3346
•
Section 4F: Employer ID Number
•
•
•
Must be a sole proprietor
Cannot reassign all of Medicare payments
If you want payments under EIN, must furnish
IRS documentation showing EIN
39
Section 4G-4H: Practice Location (cont’d)
•
Section 4G:
–
Where Do you keep Patients’ Medical Records?
•
PO Boxes and drop boxes are not acceptable
for records to be maintained
First Medical Record Storage Facility
• For current and former patients
– Indicate whether action is a change, add,
or deletion
– Date (mm/dd/yyyy)
Second Medical Record Storage Facility
• For current and former patients
– Indicate whether action is a change, add,
or deletion
– Date (mm/dd/yyyy)
•
Section 4H:
–
Unique Circumstances (home calls only)
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Section 5, 7: For Future Use
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Section 6A: Individuals Having
Managing Control
•
Section 6A:
–
Managing Employee Identifying Information
• All managing employees at any practice
location shown in Section 4 must be reported
– Indicate whether action is a change, add,
or deletion
– Date (mm/dd/yyyy)
– First name, Middle, Last name, Jr, Title
– MIN, NPI, (if issued)
– SSN (Required)
– Date of Birth (mm/dd/yyyy)
– Place of Birth (State)
– Country of Birth (e.g. USA)
– Information from Section 2A (mm/dd/yyyy)
•
Section 6B:
–
Final Adverse Legal Action History
42
Section 8: Billing Agency information
√
02/01/2015
43
Section 9 thru 12: For Future Use
• These sections are not applicable
44
Section 13: Contact Person
IMPORTANT NOTE:
[email protected]
•
Responsible for any questions
or developmental issues
•
If contact person is an
authorized or delegated official
check the appropriate box
•
Email address of individual is
the preferred contact method
45
Section 14: Penalties for Falsifying
Information
•
Explains the penalties for
deliberately falsifying
information
•
Should be read by all
individuals involved with
credentialing the supplier/
organization
46
Section 15: Certification Statement
B
Willie
Muschamp
Willie B. Muschamp M.D.
MD
02/01/2015
Information to include:
•
•
•
•
•
First name,
Last name
MD, DO, etc.
Practitioner Signature
Date Signed
47
Section 16: For Future Use
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Section 17: Supporting Documentation
•
√
You must provide applicable
documents depending on whether
you are:
– newly enrolling,
– reactivating or,
– revalidating
•
√
•
Review the mandatory items for
your provider type
Check the appropriate box to
indicate document is enclosed
49
Common 855-I Form Errors
•
Section 1A:
– Reason for application submittal is missing or completed incorrectly
– NPI number(s) missing
•
Section 2D:
– Specialties are marked with X or multiple P’s
•
Section 4A:
– Date practice first started rendering services to Medicare patients at this
location is left blank
– The “Yes” and “No” boxes in the Adverse Legal History sections and
throughout the applications are skipped or neither box is checked
50
Common 855-I Form Errors cont’d
•
CMS-855I has not been submitted along with the CMS-855R when a
physician is reassigning benefits to a group practice
•
Section 4C:
– The date started at location is blank
– Is incomplete if there is more than one location
•
Section 15:
– The certification statement is not included with the application
•
Section 17:
– Supporting Documentation Checklist is not marked and/or items on the checklist
were not sent with the application
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Application Completion Tips
•
Use PECOS or choose the appropriate version of the CMS-855
•
Complete all information and submit all supporting documentation
•
Submit a copy of the authorization agreement for EFT, CMS-588
•
Sign and date the application in blue or black ink
– Even if PECOS was used, you need to sign, date, and mail the
certification statement [with evidence of delivery available]
•
Comply with any requests from Cahaba regarding enrollment process
52
Enrollment Best Practices
• Review the PECOS tutorials and get familiar with PECOS
– Also reviewing the CMS YouTube PECOS instructional videos
• Verify that NPPES data matches IRS data and data submitted
on 855-I form
• Keep a copy of documents submitted
• Track the application through completion
53
Medicare Enrollment Resources
•
CMS website
– http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplificatio
n/NationalProvIdentStand/index.html?redirect=/nationalprovidentstand/
•
NPI Application Instructions
– https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.instructions
•
Apply for NPI
– https://nppes.cms.hhs.gov/NPPES/Welcome.do
•
CMS Revalidation Information
– http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProv
iderSupEnroll/Revalidations.html
54
MAC Satisfaction Indicator (MSI)
• Survey designed to measure satisfaction as a Medicare provider
with performance of Cahaba
– Not used for RRB, RACs, CERT contractors, ZPICs, SMRCs, or QICs
– Only takes about 10-15 minutes to complete
– Authorized by OMB and expires May 31, 2018
• Providers will be able to take the survey beginning June 15, 2015
– If you experience technical difficulties accessing or submitting the
survey once it is launched, please contact CFI Support at:
[email protected]
55
2015 Medicare Expo
•
Our 3rd Annual Medicare Expo will be held in Birmingham, AL
– Previously held in Atlanta, GA and Chattanooga, TN
– Will consist of general sessions and breakout sessions
•
Face-to-Face educational event for all providers, hospitals, office staff,
software vendors, clearinghouses, billing services, and many more
– Part A providers on August 19, 2015
– Part B providers on August 20, 2015
•
Registration is now open and you can visit the following links below
for more details:
– Register here: http://www.planetReg.com/E52717245200326
– Make Hotel Accommodations here:
https://resweb.passkey.com/Resweb.do?mode=welcome_ei_new&eventID=13932816
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Upcoming Changes
• Cahaba has been awarded the contract for administration of
all Medicare Part A and Part B claims
– Change from Jurisdiction 10 (J10) to Jurisdiction J (JJ)
– Jurisdiction still consists of Alabama, Georgia, and Tennessee
• Dedicated section on main landing webpage
– Section located below “Featured News” and before
“Welcome to Cahaba”
• Consists of special bulletin and listserv messages with details
about transition
– Some P.O. Boxes may change
– MSP, Financial, PAAR functions subcontracted
– Logo change in rebranding initiative
57
Calendar of Events Page
Date
Topic
June 24, 2015
Provider Enrollment Series – Part 3:
Submitting the CMS 855O, 855R and 588
July 8, 2015
New Provider Series – Overview
July 15, 2015
New Provider Series – Enrollment
July 22, 2015
New Provider Series – Resources/Specialized Divisions
Registration details posted at https://apps.cahabagba.com/apps/course_registration/al/calendar.jsp#
58
Question and Answer Session
59
Thank You for Attending
http://www.telspanvenue.com/SYID=EA50DB868049
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