What Medicare enrollment forms are necessary for a provider to participate. Learn whats involved with the Medicare provider application process and the benefits of Medicare provider enrollment.
If you enjoy paperwork, you’ll love filling out the Medicare enrollment forms for providers – all 29 pages of the CMS-855I Medicare provider application. Medicare provider enrollment is required in order to treat Medicare patients.
Being credentialed with Medicare as with other insurance companies is advantageous as it provides another source of patients who prefer to see a participating provider. A provider can choose to be either to participate with Medicare or not to participate with Medicare.
The benefits of being a participating Medicare provider are:
- Medicare reimbursement is 5% higher than non-participating providers.
- Payments are sent directly to the provider
- Claim information is forwarded to Medigap supplemental insurers.
Whenever a provider moves or changes tax ID, it is necessary to complete a new Medicare application. This can be a very time consuming and confusing process.
If you currently operate a medical billing service, offering Medicare provider application services can provide a way to attract new clients. There are a lot of providers are willing to pay to have this done by a someone who is knowledgeable and experienced in credentialing. These services will shepherd the Medicare forms through credentialing process, respond to inquires by the Medicare contractor, and keep the provider advised of the progress.
Need to complete a Medicare provider application correctly and promptly? “Medicare Enrollment – Completing the 855I” listed on our Medical Billing Reference Books page is valuable guide that shows you how to complete 855I forms correctly from start to finish.
Three Medicare Forms
There are three different Medicare provider enrollment application forms to enroll or change enrollment information:
Probably the most commonly used of the application forms. This Medicare provider application is for individual physicians and non-physician practitioners to start the enrollment process or change Medicare enrollment information.
For group practices and suppliers (with exception to certain DME suppliers) to enroll in or change existing Medicare enrollment information.
Medicare enrollment forms to initiate reassignment of biling rights to Medicare and receive payments. Only individual physicians and non-physicians can reassign the right to bill Medicare.
There is also a new online Medicare provider enrollment process called PECOS (Provider Enrollment, Chain and Ownership System) which will be available soon.
If a provider is enrolled in Medicare but hasn’t submitted the CMS-855 since November 2003, a complete application is required as with an initial enrollment application.
The Medicare provider application requires the assignment of an NPI (National Provider Identifier) number if the provider does not already have one. This replaces the previous provider identifiers used by Medicare.
The Medicare provider enrollment forms must be submitted with the Electronic Funds Transfer Authorization agreement (CMS-588). This allows providers to receive Medicare payments via electronic funds transfer. This is not required if the provider already receives payments electronically.
Medicare requires all supporting documents such as the electronic funds transfer authorization to be submitted with the initial application. All signature must be original and in ink – blue is preferred.
Medicare enrollment forms are available here on the CMS website.
Any requests for information from the Medicare contractor should be answered promptly to insure the enrollment is processed correctly.