Medicare Compliance & Reimbursement
Medicare Enrollment Is More Than Getting an NPI
Question: Our young practice wants to take on Medicare patients. Our two physicians have National Provider Identifiers (NPI). Can we start seeing beneficiaries? Florida Subscriber Answer: No. An NPI is just the starting point toward Medicare provider enrollment; it is not a substitute for the enrollment process. “Providers still need to apply for Medicare enrollment in order to be approved for the submission of Medicare claims,” explains Part B Medicare Administrative Contractor (MAC) WPS-GHA in online guidance. “The NPI is a required data element on the CMS 855 Medicare enrollment forms. Required NPI fields cannot be left blank and ‘pending’ is not an acceptable entry in these fields.” First: Remember, “NPIs are issued through the National Plan & Provider Enumeration System (NPPES),” reminds the Centers for Medicare & Medicaid Services (CMS) in online guidance. Interested providers can apply for an NPI on the NPPES website or check the NPI registry if they think they may already have one. Next: The easiest way to apply to become a Medicare provider is via CMS’ online application portal, the Provider Enrollment, Chain and Ownership System (PECOS) — though paper applications are still available. So, once a provider has the NPI, then they can hop on PECOS and fill out a Medicare enrollment application. Last: Your MAC “may have additional requests for information while they process your application,” which is why you must determine your jurisdiction and/or region beforehand, CMS advises. Your MAC can also offer you insight into the process and give you updates on the status of your enrollment.
Medicare Compliance & Reimbursement
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