Intensive Cardiac Rehabilitation (ICR)
A. Background
ICR programs must be approved by CMS through the national coverage determination (NCD) process and must meet certain criteria for approval. Individual sites seeking to provide ICR services via an approved ICR program must enroll with their local Medicare contractor as an ICR program supplier.
B. ICR Enrollment
In order to enroll as an ICR site, a supplier must complete a Form CMS-855B, with the supplier type of “Other” selected. The contractor shall verify that CMS has approved the ICR program through the NCD process. A list of approved ICR programs will be identified through the NCD listings, the CMS Web site and the Federal Register. The contractor shall use one of these options to verify that the ICR program has met CMS approval.
An ICR supplier must separately and individually enroll each of its practice locations. The supplier can therefore only have one practice location – which shall receive its own Provider Transaction Access Number - on its Form CMS-855B enrollment application.
The contractor shall use specialty code 31 for these enrollments.
The contractor shall only accept and process reassignments (Form CMS-855Rs) to ICR suppliers from physicians defined in section 1861(r)(1) of the Social Security Act.
It is important that the contractor review and adhere to the following regulations and instructions regarding the required qualifications of ICR suppliers:
• 42 CFR § 410.49
• Publication 100-04, Medicare Claims Processing Manual, chapter 32, sections 140.2.2 – 140.2.2.6
• Publication 100-02, Medicare Benefit Policy Manual, chapter 15, section 232
Web-Based Applications That Do Not Require A Site Visit
The contractor shall process 80 percent of all Form CMS-855 Web-based initial applications that do not require a site visit within 45 calendar days of receipt, process 90 percent of all Form CMS-855 Web-based initial applications that do not require a site visit within 60 calendar days of receipt, and process 95 percent of all Form CMS-855 Web-based initial applications that do not require a site visit within 90 calendar days of receipt. This process generally includes, but is not limited to:
• Receipt of the provider’s certification statement in the contractor’s mailroom and forwarding it to the appropriate office for review.
• Verification of the application in accordance with existing instructions.
• Requesting and receiving clarifying information in accordance with existing instructions.
Formal notification of the contractor’s decision or recommendation (and providing the appropriate appeal rights, as necessary).
Paper Applications – Accuracy
The contractor shall process 98 percent of paper CMS-855 initial applications in full accordance with all of the instructions in this chapter (with the exception of the timeliness standards identified in sections 15.6.1.1.1 through 15.6.1.1.4 of this chapter) and all other applicable CMS directives.
Web-Based Applications - Timeliness
The contractor shall process 90 percent of Form CMS-855 Web-based initial applications within 45 calendar days of receipt, process 95 percent of Form CMS-855 Web-based initial applications within 60 calendar days of receipt, and process 99 percent of Form CMS-855 Web-based initial applications within 90 calendar days of receipt. This process generally includes, but is not limited to:
• Receipt of the provider’s certification statement in the contractor’s mailroom and forwarding it to the appropriate office for review.
• Verification of the application in accordance with existing instructions.
• Requesting and receiving clarifying information in accordance with existing instructions.
• Supplier site visit (if required).
• Formal notification of the contractor’s decision or recommendation (and providing the appropriate appeal rights, as necessary).
Web-Based Applications - Accuracy
The contractor shall process 98 percent of Form CMS-855 Web-based initial applications in full accordance with all of the instructions in this chapter (with the exception of the timeliness standards identified in section 15.6.1.3 above) and all other applicable CMS directives.
Standards for Changes of Information
For purposes of timeliness, the term “changes of information” also includes:
1. Form CMS-855 change of ownership, acquisition/merger, and consolidation applications submitted by the old owner
2. Form CMS-588 changes submitted without a need for an accompanying complete Form CMS-855 application
3. Form CMS-855R applications submitted independently (i.e., without being part of a Form CMS-855I or Form CMS-855B package)
4. Form CMS-855 voluntary terminations
Paper Applications - Timeliness
The contractor shall process 80 percent of paper Form CMS-855 changes of information within 60 calendar days of receipt, and process 95 percent of paper Form CMS-855 changes of information within 120 calendar days of receipt. This process generally includes, but is not limited to, the following activities:
• Receipt of the change request in the contractor’s mailroom and forwarding it to the appropriate office for review.
• Prescreening the change request in accordance with existing instructions.
• Creating an L & T record and, if applicable, tying it to an enrollment record in PECOS.
• Verification of the change request in accordance with existing instructions.
• Requesting and receiving clarifying information in accordance with existing instructions.
• Supplier site visit (if necessary).
• Formal notification of the contractor’s decision or recommendation (and providing the appropriate appeal rights, as necessary).
A. Background
ICR programs must be approved by CMS through the national coverage determination (NCD) process and must meet certain criteria for approval. Individual sites seeking to provide ICR services via an approved ICR program must enroll with their local Medicare contractor as an ICR program supplier.
B. ICR Enrollment
In order to enroll as an ICR site, a supplier must complete a Form CMS-855B, with the supplier type of “Other” selected. The contractor shall verify that CMS has approved the ICR program through the NCD process. A list of approved ICR programs will be identified through the NCD listings, the CMS Web site and the Federal Register. The contractor shall use one of these options to verify that the ICR program has met CMS approval.
An ICR supplier must separately and individually enroll each of its practice locations. The supplier can therefore only have one practice location – which shall receive its own Provider Transaction Access Number - on its Form CMS-855B enrollment application.
The contractor shall use specialty code 31 for these enrollments.
The contractor shall only accept and process reassignments (Form CMS-855Rs) to ICR suppliers from physicians defined in section 1861(r)(1) of the Social Security Act.
It is important that the contractor review and adhere to the following regulations and instructions regarding the required qualifications of ICR suppliers:
• 42 CFR § 410.49
• Publication 100-04, Medicare Claims Processing Manual, chapter 32, sections 140.2.2 – 140.2.2.6
• Publication 100-02, Medicare Benefit Policy Manual, chapter 15, section 232
Web-Based Applications That Do Not Require A Site Visit
The contractor shall process 80 percent of all Form CMS-855 Web-based initial applications that do not require a site visit within 45 calendar days of receipt, process 90 percent of all Form CMS-855 Web-based initial applications that do not require a site visit within 60 calendar days of receipt, and process 95 percent of all Form CMS-855 Web-based initial applications that do not require a site visit within 90 calendar days of receipt. This process generally includes, but is not limited to:
• Receipt of the provider’s certification statement in the contractor’s mailroom and forwarding it to the appropriate office for review.
• Verification of the application in accordance with existing instructions.
• Requesting and receiving clarifying information in accordance with existing instructions.
Formal notification of the contractor’s decision or recommendation (and providing the appropriate appeal rights, as necessary).
Paper Applications – Accuracy
The contractor shall process 98 percent of paper CMS-855 initial applications in full accordance with all of the instructions in this chapter (with the exception of the timeliness standards identified in sections 15.6.1.1.1 through 15.6.1.1.4 of this chapter) and all other applicable CMS directives.
Web-Based Applications - Timeliness
The contractor shall process 90 percent of Form CMS-855 Web-based initial applications within 45 calendar days of receipt, process 95 percent of Form CMS-855 Web-based initial applications within 60 calendar days of receipt, and process 99 percent of Form CMS-855 Web-based initial applications within 90 calendar days of receipt. This process generally includes, but is not limited to:
• Receipt of the provider’s certification statement in the contractor’s mailroom and forwarding it to the appropriate office for review.
• Verification of the application in accordance with existing instructions.
• Requesting and receiving clarifying information in accordance with existing instructions.
• Supplier site visit (if required).
• Formal notification of the contractor’s decision or recommendation (and providing the appropriate appeal rights, as necessary).
Web-Based Applications - Accuracy
The contractor shall process 98 percent of Form CMS-855 Web-based initial applications in full accordance with all of the instructions in this chapter (with the exception of the timeliness standards identified in section 15.6.1.3 above) and all other applicable CMS directives.
Standards for Changes of Information
For purposes of timeliness, the term “changes of information” also includes:
1. Form CMS-855 change of ownership, acquisition/merger, and consolidation applications submitted by the old owner
2. Form CMS-588 changes submitted without a need for an accompanying complete Form CMS-855 application
3. Form CMS-855R applications submitted independently (i.e., without being part of a Form CMS-855I or Form CMS-855B package)
4. Form CMS-855 voluntary terminations
Paper Applications - Timeliness
The contractor shall process 80 percent of paper Form CMS-855 changes of information within 60 calendar days of receipt, and process 95 percent of paper Form CMS-855 changes of information within 120 calendar days of receipt. This process generally includes, but is not limited to, the following activities:
• Receipt of the change request in the contractor’s mailroom and forwarding it to the appropriate office for review.
• Prescreening the change request in accordance with existing instructions.
• Creating an L & T record and, if applicable, tying it to an enrollment record in PECOS.
• Verification of the change request in accordance with existing instructions.
• Requesting and receiving clarifying information in accordance with existing instructions.
• Supplier site visit (if necessary).
• Formal notification of the contractor’s decision or recommendation (and providing the appropriate appeal rights, as necessary).
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