Medicare Compliance & Reimbursement

As if the new Medicare enrollment process wasn't confusing enough, CMS has revised its written rules on submitting your CMS-855 enrollment application.

According to new transmittal 292, dated June 12, CMS lists over a dozen mistakes that providers might make that would cause their carrier to immediately return their enrollment application.

Most of the reasons, including an unsigned CMS-855 or a stamped signature on the form, are old news to practices who already knew not to make these errors.

However, CMS now adds three parameters to the rule, reminding the medical community not to send in their CMS-855 forms too early, notes Barbara J. Cobuzzi,MBA, CPC,CPC-H, CPC-P, CENTC, CHCC, president of CRN Healthcare Solutions in Tinton Falls, N.J.

CMS will now immediately return an application that meets the following criteria, the transmittal indicates:

• From a certified provider or supplier more than 90 days prior to the effective date listed on the application

• From a physician or physician group working in a hospital setting who submits an application more than 60 days prior to the effective date on the application

• From any other supplier type (not listed in the first two bullets above) submitted more than 30 days prior to the effective date on the application.

"This requires practices to be extremely diligent," says San Francisco-based coding consultant Rebecca Scott. "At this point, you can't submit your application too early, but if you wait too long, you risk not getting accredited. If you have a new physician joining your practice, you have to stay very organized to ensure you're submitting yourapplication at the right time."