JK: Provider Enrollment 855I and 855R 1532_0214
Presenters Carleen Parker Provider Outreach & Education Donna Pisani Provider Outreach & Education 2 National Government Services, Inc.
Disclaimer National Government Services, Inc. has produced this material as an informational reference for providers furnishing services in our contract jurisdiction. National Government Services employees, agents, and staff make no representation, warranty, or guarantee that this compilation of Medicare information is error-free and will bear no responsibility or liability for the results or consequences of the use of this material. Although every reasonable effort has been made to assure the accuracy of the information within these pages at the time of publication, the Medicare Program is constantly changing, and it is the responsibility of each provider to remain abreast of the Medicare Program requirements. Any regulations, policies and/or guidelines cited in this publication are subject to change without further notice. Current Medicare regulations can be found on the Centers for Medicare & Medicaid Services (CMS) Web site at http://www.cms.gov. 3 National Government Services, Inc.
No Recording Attendees/providers are never permitted to record (tape record or any other method) our educational events This applies to our Webinars, teleconferences, live events, and any other type of National Government Services educational event 4 National Government Services, Inc.
Acronyms Please access the Acronyms page on the http://www.ngsmedicare.com Web site to view any acronym used within this presentation 5 National Government Services, Inc.
Objectives Identify 855I and 855R application Properly submit a completed 855I and the 855R application with required documents Utilize resources, self-service products, and contact information for assistance 6 National Government Services, Inc.
Agenda Enrollment provisions 855I 855R Overview Maintaining reassignments Adding new reassignments Terminating reassignment Contact information and references 7 National Government Services, Inc.
Provider Enrollment First Steps The National Provider Identifier (NPI) First, apply for your NPI National Plan and Provider Enumeration System (NPPES) Then, apply for your Provider Transaction Access Number (PTAN) JK National Government Services (CT, MA, ME, NH, NY, RI, and VT) 8 National Government Services, Inc.
National Plan and Provider Enumeration System https://npiregistry.cms.hhs.gov/nppesregistry/npiregistryh ome.do 9 National Government Services, Inc.
National Plan and Provider Enumeration System Creating an NPPES User ID and password Not sure if you ever created one Cannot remember what they are Contact the NPI Enumerator for assistance at 800-465-3203 10 National Government Services, Inc.
Not Eligible Providers/practitioners/suppliers who frequently attempt to enroll in Medicare, but are not eligible to do so No statute permits them to bill Medicare 11 National Government Services, Inc.
Not Eligible Acupuncturist Assisted living facilities Certified social worker Hearing aid center Massage therapist Licensed practical nurse Marriage family therapist Masters social work PT/ O/T Assistants Registered nurse Speech and hearing center Substance abuse facility 12 National Government Services, Inc.
Not Eligible Certified alcohol and drug counselor Drug and alcohol rehabilitation counselor Licensed professional counselor Mental health counselor National certified counselor 13 National Government Services, Inc.
Who Is Eligible to Credential Physicians and nonphysician practitioners CMS-855I is individual application physician/nonphysician practitioners CMS-855R links a provider to a group for reassignments 14 National Government Services, Inc.
Physicians and Nonphysician Practitioners Anesthesiologist Audiologist CNM CRNA CNS LCSW Mass immunization roster biller NP PT/OT/SLP in private practice PT in private practice Physician assistant Psychologist, clinical Psychologist billing independently Registered dietitian or nutrition professional 15 National Government Services, Inc.
Who Completes the 855I Application All individuals (physicians and non physician practitioners) who will be providing services to Medicare beneficiaries must complete form CMS-855I 16 National Government Services, Inc.
Who Completes the 855I Application Anesthesiologist Audiologist CNM CRNA CNS LCSW Mass immunization roster biller NP PT/OT/SLP in private practice PT in private practice Physician assistant Psychologist, clinical Psychologist billing independently Registered dietitian or nutrition professional 17 National Government Services, Inc.
Who Completes the 855I Private practice Application Individual in a group setting Individual sole owner professional corporation professional association limited liability company Individual practicing in another geographic territory Changes to existing records 18 National Government Services, Inc.
Reportable Physician Changes Enrollment information change Change that affects Medicare enrollment record Report changes as soon as possible Ensure claims process 19 National Government Services, Inc.
Reportable Event Changes within 30 days Changes of ownership Changes in practice location Final adverse legal actions License suspension, felony conviction, debarment Failure may result in revocation 20 National Government Services, Inc.
Reportable Event Changes within 90 days Any individual or group changes Practice status, business structure, legal business name, TIN, banking data, correspondence or special payment address CMS-855B and 855I Section 1A and 1B 21 National Government Services, Inc.
Application Types Providers options Internet-based Provider Enrollment, Chain and Ownership System (PECOS), or Paper enrollment application process (e.g., Form CMS-855I) Enrollment applications are CMS maintained 22 National Government Services, Inc.
Internet-Based PECOS NPPES User ID and password Need help? Creating an NPPES User ID and password Not sure if you ever created one Cannot remember what they are NPI Enumerator 800-465-3203 23 National Government Services, Inc.
Avoid Delays Complete all required sections Correspondence address Special payments address Enter your NPI Enter all applicable dates Sign Send supporting documentation 24 National Government Services, Inc.
Accessing Applications Go to http://www.ngsmedicare.com Home page 25 National Government Services, Inc.
Accessing Applications 26 National Government Services, Inc.
Accessing Applications Internet-based PECOS Forms 27 National Government Services, Inc.
Accessing Applications Internet-based PECOS Forms 28 National Government Services, Inc.
855I 29 National Government Services, Inc.
Section 1 Basic Information Physician assistants must furnish their Medicare Identification Number(s) and NPI The Medicare Identification Number(s) (if already issued) and the individual (type 1) NPI 30 National Government Services, Inc.
Section 1 Basic Information Section 1B Basic Information Check all that apply Complete the required sections 31 National Government Services, Inc.
Section 2A Identifying Information Section 2A Personal Information Provide name, Date of birth, and Social Security number The SSN must coincide with the information on your Social Security record 32 National Government Services, Inc.
Section 2B Identifying Information Section 2B Correspondence Address Provide contact information for the person shown in Section 2A Once enrolled, the information provided here will be used by the contractor to contact you directly 33 National Government Services, Inc.
Section 2C Identifying Information Section 2C Resident/Fellow Status If you are a resident or in a fellowship program, answer the questions listed including the name of the teaching hospital/facility 34 National Government Services, Inc.
Section 2D Identifying Information Section 2D1 Medical Specialties Select a primary specialty (designated with a P ); then you may select multiple secondary specialties (designated with S ) 35 National Government Services, Inc.
Section 2D Identifying Information Section 2D2 Nonphysician Practitioners Select specialty here You shall meet the licensing, educational, and work experience requirements 36 National Government Services, Inc.
Section 2 E, F, G Identifying Information Physician assistants: Section 2E Establishing employment Section 2F Terminating Employment Section 2G Employer terminating Employment arrangement 37 National Government Services, Inc.
Section 2H Identifying Information Section 2H Clinical Psychologists Shall hold a doctorial degree in psychology A copy of the degree must be submitted with application 38 National Government Services, Inc.
Section 2I Identifying Information Section 2I Psychologists Billing Independently Related to billing independently All questions shall be answered 39 National Government Services, Inc.
Section 2J Identifying Information Section 2J Physical Therapists/Occupational Therapists (PT/OT) This section applies only to PT/OT in private practice This section does not apply if PT/OT is reassigning all benefits to a group 40 National Government Services, Inc.
Section 2K Identifying Information Section 2K Nurse Practitioners and Certified Clinical Nurse Specialist This section applies if you are an employee of a Medicare Skilled Nursing Facility (SNF) or of another entity that has an agreement to provide nursing services in a SNF 41 National Government Services, Inc.
Section 2L Identifying Information Section 2L Advanced Diagnostic Imaging (ADI) Suppliers Only Medicare for ADI services ADI services MUST be accredited in each ADI Modality to qualify to bill Medicare for those services 42 National Government Services, Inc.
Section 3 - Final Adverse Legal Actions/Convictions Section 3 Important to read Final adverse legal actions, such as convictions, exclusions, revocations, and suspensions 43 National Government Services, Inc.
Section 3 - Final Adverse Legal Actions/Convictions Section 3 / 1 & 2 If None, check No If there are, please list and attach final adverse legal action documentation and/or resolutions 44 National Government Services, Inc.
Section 4 - Practice Location Information Section 4A Establishing a Professional Corporation, Professional Association, Limited Liability Company, etc. 45 National Government Services, Inc.
Section 4 - Practice Location Information Section 4B - Individual Affiliations Complete with your private practice and group affiliations Groups reported in this section must complete and submit a CMS-855R with this application 46 National Government Services, Inc.
Section 4 - Practice Location Information Section 4C - Practice Location Information If a provider sees patients in more than one practice location, copy and complete this section for each location Changing, adding, or deleting 47 National Government Services, Inc.
Section 4 - Practice Location Information Section 4D Rendering services in the patient s home Reporting entire state or deleting an entire state Changing, adding, or deleting, check the appropriate box and furnish the effective date 48 National Government Services, Inc.
Section 4 - Practice Location Information Section 4E Where do providers want the Remittance Notices or Special Payments sent Changing, adding, or deleting, check the appropriate box and furnish the effective date EFT required 49 National Government Services, Inc.
Section 4 - Practice Location Information Section 4F Employer ID Number Information Sole proprietor payments to be reported under the EIN Unless indicated, payments will be made under the SSN Cannot use both EIN and SSN 50 National Government Services, Inc.
Section 4 - Practice Location Information Section 4G Where do providers keep patients Medicare records If medical records other than the location shown in section 4C, please complete this section Name, address, storage location 51 National Government Services, Inc.
Section 4 - Practice Location Information Section 4H Unique circumstances Explain any unique circumstance Practice locations Method by which you render health care services Example: only render services in patients homes, such as house calls 52 National Government Services, Inc.
Section 5 Reserved for future use This section is not applicable at this time 53 National Government Services, Inc.
Section 6 Individuals Having Managing Control Section 6A Individuals having managing control If more than one managing employee, copy this section and complete for each 54 National Government Services, Inc.
Section 6 Individuals Having Managing Control Section 6B Final adverse legal action history Individuals reported in 6A If changing information, check the change box and furnish effective date Attach copy of any final adverse 55 National Government Services, Inc.
Section 7 Reserved for future use This section is not applicable at this time 56 National Government Services, Inc.
Section 8 Billing Agency Information Section 8 Billing agency information Applicants that use a billing agency, shall complete this section Providers using a billing agency are responsible for claims submitted on their behalf 57 National Government Services, Inc.
Sections 9, 10, 11, & 12 58 National Government Services, Inc.
Section 13 Contact Person Section 13 Contact person We will need to contact the individual shown here in section 13 List the person you would like us to contact regarding your application All numbers & e-mail 59 National Government Services, Inc.
Section 14 Penalties for Falsifying Information Section 14 Penalties for falsifying information Read Penalties for deliberately furnishing false information 60 National Government Services, Inc.
Section 15 Certification Statement Section 15 Certification Statement Providers sign and date Attests to meeting and maintaining the Medicare requirements Must be originals and in ink 61 National Government Services, Inc.
Section 17 Supporting Documents Section 17 Supporting documents Required documentation 62 National Government Services, Inc.
Section 17 Supporting Documents 63 National Government Services, Inc.
New Electronic Funds Transfer (EFT) Authorization Agreement Only CMS-588 (09/13) version of EFT form accepted as of January 1, 2014 CMS-588 (05/10) no longer accepted If submitted, will be returned to provider with explanatory letter 64 National Government Services, Inc.
855R 65 National Government Services, Inc.
855R Overview After enrollment in the Medicare Program Physicians and non physician practitioners can reassign Medicare payments Make a change in their reassignment of Medicare benefit Terminate a reassignment of Medicare benefits 66 National Government Services, Inc.
855I and 855R The 855I shall be completed for a new individual enrolling in Medicare The 855R tells Medicare you are reassigning all or some of your benefits to a group. 67 National Government Services, Inc.
855R Overview 855R application is completed by a supplier signed by the individual practitioner submitted by the supplier Terminating reassignment supplier or the individual practitioner may submit 68 National Government Services, Inc.
Maintaining Reassignments Responsibility individual authorized official delegated official Agrees to notify the Medicare contractor of any future changes 69 National Government Services, Inc.
855R Reassignments Not Necessary An individual (sole owner) will not need to reassign benefits to the following: corporation limited liability company professional association Physician Assistants sections 2E through 2G of the CMS-855I do not complete the CMS-855R 70 National Government Services, Inc.
Terminating A Current Reassignment Individual practitioner terminating reassignment Section 2 No reassigned claims will be paid to the supplier for services rendered by the practitioner after the effective date of deletion 71 National Government Services, Inc.
Terminating A Current Reassignment Organization terminating reassignment Section 3 No reassigned claims will be paid to the supplier for services rendered by the practitioner after the effective date of deletion 72 National Government Services, Inc.
Section 1 - Basic Information Section 1 Basic Why are you submitting All applicants shall check the applicable box 73 National Government Services, Inc.
Section 2 - Organization Receiving The Reassigned Benefits Section 2 and 3 Organization receiving reassignment Organization/supplier information Individual practitioner reassigning benefits Full name, EIN, PTAN, SSN, & NPI 74 National Government Services, Inc.
Section 4 - Authorization Statements New Reassignment Section 4A completed by the individual practitioner Section 4B completed by an authorized or delegated official of the supplier 75 National Government Services, Inc.
Section 4 - Authorization Statements Terminating Section 4A must be completed by the individual practitioner Section 4B must be completed by an authorized or delegated official of the supplier 76 National Government Services, Inc.
Sections 5 and 6 77 National Government Services, Inc.
Section 7 - Contact Person List contact person you want us to communicate with We may need to contact the individual Include informationtelephone number, fax number, e-mail, and address 78 National Government Services, Inc.
National Government Services Provider Enrollment Line Jurisdiction K: 888-379-3807 Hours Available Monday through Friday 7:00 a.m. 6:00 p.m. ET Call for assistance with: Enrollment status CMS-855 form completion Other enrollment related questions 79 National Government Services, Inc.
National Government Services Provider Enrollment Line Can assist with any question/issue: Contact person on application Actual provider Authorized/delegated official for practice For all other callers, can only provide general case status: Received Pending Finalized 80 National Government Services, Inc.
Other Questions? National Government Services Jurisdiction K Provider Contact Center 866-837-0241 TTY: 866-786-7155 All National Government Services phone numbers http://www.ngsmedicare.com > Resources > Contact Us 81 National Government Services, Inc.
Mailing Information Mailing CMS-855 Forms, shall be mailed to: National Government Services, Inc. P.O. Box 7149 Indianapolis, IN 46207-7149 82 National Government Services, Inc.
Provider Enrollment Self-Service Tools Please visit our Web site for the great selfservice tools that we have to offer Our PE inquiry tool can be used to check on the status of your CMS-855 enrollment application http://www.ngsmedicare.com/ngs/portal/ngsmedicare/ provider_enrollment 83 National Government Services, Inc.
National Government Services Provider Enrollment Resources Part B > Enrollment > Enrollment Tools Topics Enrollment Change Scenarios Initial Enrollment Scenarios Revalidation Scenarios Supplemental Enrollment Resources 84 National Government Services, Inc.
CMS Resources The Centers for Medicare & Medicaid Services Internet-Only Manual, Publication 100-08, Medicare Program Integrity Manual, Chapter 15 http://www.cms.gov/regulations-and- Guidance/Guidance/Manuals/Downloads/pim83c15.pdf 855R Medicare Enrollment Application http://www.cms.gov/medicare/cms-forms/cms- Forms/downloads/cms855r.pdf 85 National Government Services, Inc.
CMS Resources PECOS http://www.cms.gov/medicare/provider-enrollment-and- Certification/MedicareProviderSupEnroll/index.html?redire ct=/medicareprovidersupenroll/04_internetbasedpecos. asp 855I Medicare Enrollment Application https://www.cms.gov/medicare/cms-forms/cms- Forms/downloads/cms855i.pdf 86 National Government Services, Inc.
E-mail Updates Subscribe to receive the latest, up-to-date Medicare information 87 National Government Services, Inc.
Web Site Survey This is your chance to have your voice heard Say yes when you see this pop-up so National Government Services can make your job easier! 88 National Government Services, Inc.
Medicare University http://www.medicareuniversity.com Interactive online system available 24/7 Educational opportunities available Computer-based training courses Teleconferences, Webinars, live seminars/face-toface training Self-report attendance 89 National Government Services, Inc.
Medicare University Self-Reporting Instructions Log on to the National Government Services Medicare University site at http://www.medicareuniversity.com Topic = JK: Part B Completing the CMS 855I and 855R Provider Enrollment Forms Medicare University Credits (MUCs) = 1 Catalog Number = To be provided Course Code = To be provided For step-by-step instructions on self-reporting please visit http://www.ngsmedicare.com > Medicare University > Accessing the Self-Reporting Tool 90 National Government Services, Inc.
Thank You! 91 National Government Services, Inc.