Certified Registered Nurse Anesthetists (CRNAs)
Federal regulations at 42 CFR § 410.69(b) state that a CRNA is a registered nurse who:
(1) Is licensed as a registered professional nurse by the state in which the nurse practices;
(2) Meets any licensure requirements the state imposes with respect to non-physician anesthetists;
(3) Has graduated from a nurse anesthesia educational program that meets the standards of the Council on Accreditation of Nurse Anesthesia Programs, or such other accreditation organization as may be designated by the Secretary; and
(4) Meets the following criteria:
(i) Has passed a certification examination of the Council on Certification of Nurse Anesthetists, the Council on Recertification of Nurse Anesthetists, or any other certification organization that may be designated by the Secretary; or
(ii) Is a graduate of a program described in paragraph (3) and within 24 months after that graduation meets the requirements of paragraph (4)(i).
For more information on CRNAs, refer to:
• Section 1861(bb) of the Social Security Act
Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, section 140.1
Supporting Documents
When documentation of the provider’s or supplier’s TIN and/or LBN is required, the contractor may accept a CP-575, a federal tax department ticket, or any other pre-printed document from the IRS that identifies the TIN and/or LBN.
Ambulance Attachment
A. Geographic Area
1. Multiple States
The applicant must list the geographic areas in which it provides services. If the supplier indicates that it provides services:
• In more than one contractor's jurisdiction, it must submit a separate Form CMS-855B to each contractor.
• In more than one state but within the same contractor jurisdiction, the contractor shall review section 15.5.4.2(D) of this chapter to determine whether a separate enrollment for the additional state is required.
2. Practice Location
For purposes of provider enrollment, the following are considered ambulance “practice locations”:
• A site at which the supplier’s vehicles are garaged
• A site from which the supplier’s personnel are dispatched
• The supplier’s base of operations (i.e., the supplier’s primary headquarters). The supplier can only have one base of operations.
Hence, if an ambulance supplier submits a Form CMS-855B to add to its enrollment record a site at which the supplier’s vehicles are garaged or from which personnel are dispatched, the supplier must pay an application fee.
3. Examples
Consider the following scenarios:
a. The ambulance supplier is enrolling and performing services in multiple states but within only 1 contractor jurisdiction: The supplier would have to list on its Form CMS-855B each city/state/zip code in which it performs services. Its base of operations and all other practice locations would also have to be listed, and all licensure/certification requirements would have to be met for each state in which it performs services. However, separate Form CMS-855B applications for each state would only be required if all 5 conditions described in section 15.5.4.2(D) of this chapter are met. (If separate applications are not required, the contractor shall still create a separate Provider Enrollment, Chain and Ownership System (PECOS) record for each state.)
b. The ambulance supplier is enrolling (and has its base of operations) in Contractor Jurisdiction X. Its vehicles perform services in X and in adjacent Contractor Jurisdiction Y: The supplier would have to enroll with X and Y. For its Contractor X CMS-855B, the supplier would have to list all of the data mentioned in Example (a) above. For its Contractor Y CMS-855B, the supplier would have to (1) list the cities/zip codes in Y in which it performs services, (2) list its Jurisdiction X base of operations and any practice locations in Jurisdiction Y, and (3) meet all licensure/certification requirements for the state(s) in Y in which the supplier performs services.
B. Licensure Information
With respect to licensure:
• The contractor shall ensure that the supplier is appropriately licensed and/or certified, as applicable.
• An air ambulance supplier that is enrolling in a State to which it flies in order to pick up patients (that is, a State other than where its base of operations is located) is not required to have a practice location or place of business in that State. So long as the air ambulance supplier meets all other criteria for enrollment in Medicare, the contractor for that State may not deny the supplier's enrollment application solely on the grounds that the supplier does not have a practice location in that State. (This policy only applies to air ambulance suppliers.)
C. Paramedic Intercept Information
Paramedic intercept services typically involves an arrangement between a basic life support (BLS) ambulance supplier and an advanced life support (ALS) ambulance supplier, whereby the latter provides the ALS services and the BLS supplier provides the transportation component. (See 42 CFR § 410.40 for more information.) If the applicant indicates that it has such an arrangement, it must attach a copy of the agreement/contract.
D. Air Ambulances
Air ambulance suppliers must submit the following:
(1) A written statement signed by the president, chief executive officer, or chief operating officer that gives the name and address of the facility where the aircraft is hangared; and
(2) Proof that the air ambulance supplier or its leasing company possesses a valid charter flight license (FAA Part 135 Certificate) for the aircraft being used as an air ambulance. Any of the following constitutes acceptable proof:
• If the air ambulance supplier or provider owns the aircraft, the owner's name on the FAA Part 135 certificate must be the same as the supplier's or provider’s name on the enrollment application.
• If the air ambulance supplier or provider owns the aircraft but contracts with an air services vendor to supply pilots, training and/or vehicle maintenance, the FAA Part 135 certificate must be issued in the name of the air services vendor. A certification from the supplier or provider must also attest that it has an agreement with the air services vendor and must list the date of that agreement. A copy of the FAA Part 135 Certificate must accompany the enrollment application.
• If the air ambulance supplier or provider leases the aircraft from another entity, a copy of the lease agreement must accompany the enrollment application. The name of the company leasing the aircraft from that other entity must be the same as the supplier's or provider’s name on the enrollment application. The air ambulance supplier shall maintain all applicable Federal and State licenses and certifications, including pilot certifications, instrument and medical certifications and air worthiness certifications.
In addition:
• The contractor shall access the following FAA Web site on a quarterly basis to validate all licenses/certifications of air ambulance operators that are enrolled with the contractor: http://www.faa.gov/about/office_org/headquarters_offices/agc/operations/agc300/reports
• The contractor shall deny or revoke the enrollment of an air ambulance supplier if the supplier does not maintain its FAA certification or any other applicable licenses.
E. Hospital-Based Ambulances
An ambulance service that is owned and operated by a hospital need not complete a Form CMS-855B if:
• The ambulance services will appear on the hospital’s cost-report; and
• The hospital possesses all licenses required by the State or locality to operate the ambulance service.
If the hospital decides to divest itself of the ambulance service, the latter will have to complete a Form CMS-855B if it wishes to bill Medicare.
Federal regulations at 42 CFR § 410.69(b) state that a CRNA is a registered nurse who:
(1) Is licensed as a registered professional nurse by the state in which the nurse practices;
(2) Meets any licensure requirements the state imposes with respect to non-physician anesthetists;
(3) Has graduated from a nurse anesthesia educational program that meets the standards of the Council on Accreditation of Nurse Anesthesia Programs, or such other accreditation organization as may be designated by the Secretary; and
(4) Meets the following criteria:
(i) Has passed a certification examination of the Council on Certification of Nurse Anesthetists, the Council on Recertification of Nurse Anesthetists, or any other certification organization that may be designated by the Secretary; or
(ii) Is a graduate of a program described in paragraph (3) and within 24 months after that graduation meets the requirements of paragraph (4)(i).
For more information on CRNAs, refer to:
• Section 1861(bb) of the Social Security Act
Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, section 140.1
Supporting Documents
When documentation of the provider’s or supplier’s TIN and/or LBN is required, the contractor may accept a CP-575, a federal tax department ticket, or any other pre-printed document from the IRS that identifies the TIN and/or LBN.
Ambulance Attachment
A. Geographic Area
1. Multiple States
The applicant must list the geographic areas in which it provides services. If the supplier indicates that it provides services:
• In more than one contractor's jurisdiction, it must submit a separate Form CMS-855B to each contractor.
• In more than one state but within the same contractor jurisdiction, the contractor shall review section 15.5.4.2(D) of this chapter to determine whether a separate enrollment for the additional state is required.
2. Practice Location
For purposes of provider enrollment, the following are considered ambulance “practice locations”:
• A site at which the supplier’s vehicles are garaged
• A site from which the supplier’s personnel are dispatched
• The supplier’s base of operations (i.e., the supplier’s primary headquarters). The supplier can only have one base of operations.
Hence, if an ambulance supplier submits a Form CMS-855B to add to its enrollment record a site at which the supplier’s vehicles are garaged or from which personnel are dispatched, the supplier must pay an application fee.
3. Examples
Consider the following scenarios:
a. The ambulance supplier is enrolling and performing services in multiple states but within only 1 contractor jurisdiction: The supplier would have to list on its Form CMS-855B each city/state/zip code in which it performs services. Its base of operations and all other practice locations would also have to be listed, and all licensure/certification requirements would have to be met for each state in which it performs services. However, separate Form CMS-855B applications for each state would only be required if all 5 conditions described in section 15.5.4.2(D) of this chapter are met. (If separate applications are not required, the contractor shall still create a separate Provider Enrollment, Chain and Ownership System (PECOS) record for each state.)
b. The ambulance supplier is enrolling (and has its base of operations) in Contractor Jurisdiction X. Its vehicles perform services in X and in adjacent Contractor Jurisdiction Y: The supplier would have to enroll with X and Y. For its Contractor X CMS-855B, the supplier would have to list all of the data mentioned in Example (a) above. For its Contractor Y CMS-855B, the supplier would have to (1) list the cities/zip codes in Y in which it performs services, (2) list its Jurisdiction X base of operations and any practice locations in Jurisdiction Y, and (3) meet all licensure/certification requirements for the state(s) in Y in which the supplier performs services.
B. Licensure Information
With respect to licensure:
• The contractor shall ensure that the supplier is appropriately licensed and/or certified, as applicable.
• An air ambulance supplier that is enrolling in a State to which it flies in order to pick up patients (that is, a State other than where its base of operations is located) is not required to have a practice location or place of business in that State. So long as the air ambulance supplier meets all other criteria for enrollment in Medicare, the contractor for that State may not deny the supplier's enrollment application solely on the grounds that the supplier does not have a practice location in that State. (This policy only applies to air ambulance suppliers.)
C. Paramedic Intercept Information
Paramedic intercept services typically involves an arrangement between a basic life support (BLS) ambulance supplier and an advanced life support (ALS) ambulance supplier, whereby the latter provides the ALS services and the BLS supplier provides the transportation component. (See 42 CFR § 410.40 for more information.) If the applicant indicates that it has such an arrangement, it must attach a copy of the agreement/contract.
D. Air Ambulances
Air ambulance suppliers must submit the following:
(1) A written statement signed by the president, chief executive officer, or chief operating officer that gives the name and address of the facility where the aircraft is hangared; and
(2) Proof that the air ambulance supplier or its leasing company possesses a valid charter flight license (FAA Part 135 Certificate) for the aircraft being used as an air ambulance. Any of the following constitutes acceptable proof:
• If the air ambulance supplier or provider owns the aircraft, the owner's name on the FAA Part 135 certificate must be the same as the supplier's or provider’s name on the enrollment application.
• If the air ambulance supplier or provider owns the aircraft but contracts with an air services vendor to supply pilots, training and/or vehicle maintenance, the FAA Part 135 certificate must be issued in the name of the air services vendor. A certification from the supplier or provider must also attest that it has an agreement with the air services vendor and must list the date of that agreement. A copy of the FAA Part 135 Certificate must accompany the enrollment application.
• If the air ambulance supplier or provider leases the aircraft from another entity, a copy of the lease agreement must accompany the enrollment application. The name of the company leasing the aircraft from that other entity must be the same as the supplier's or provider’s name on the enrollment application. The air ambulance supplier shall maintain all applicable Federal and State licenses and certifications, including pilot certifications, instrument and medical certifications and air worthiness certifications.
In addition:
• The contractor shall access the following FAA Web site on a quarterly basis to validate all licenses/certifications of air ambulance operators that are enrolled with the contractor: http://www.faa.gov/about/office_org/headquarters_offices/agc/operations/agc300/reports
• The contractor shall deny or revoke the enrollment of an air ambulance supplier if the supplier does not maintain its FAA certification or any other applicable licenses.
E. Hospital-Based Ambulances
An ambulance service that is owned and operated by a hospital need not complete a Form CMS-855B if:
• The ambulance services will appear on the hospital’s cost-report; and
• The hospital possesses all licenses required by the State or locality to operate the ambulance service.
If the hospital decides to divest itself of the ambulance service, the latter will have to complete a Form CMS-855B if it wishes to bill Medicare.
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