Suppliers Not Eligible to Participate
Below is a list of individuals and entities that frequently attempt to enroll in Medicare, but are not eligible to do so. If the contractor receives an enrollment application from any of these individuals or entities, the contractor shall deny the application.
• Acupuncturist
• Assisted Living Facility
• Birthing Center
• Certified Alcohol and Drug Counselor
• Certified Social Worker
• Drug and Alcohol Rehabilitation Counselor
• Hearing Aid Center/Dealer
• Licensed Alcoholic and Drug Counselor
• Licensed Massage Therapist
• Licensed Practical Nurse
• Licensed Professional Counselor
• Marriage Family Therapist
• Master of Social Work
• Mental Health Counselor
• National Certified Counselor
• Occupational Therapist Assistant
• Physical Therapist Assistant
• Registered Nurse
• Speech and Hearing Center
• Substance Abuse Facility
Sections of the Forms CMS-855A, CMS-855B, and CMS-855I
A. Background
Sections 15.5.1 through 15.5.19.7 below discuss various data elements on the Form CMS-855A, Form CMS-855B, and Form CMS-855I. Not every data element on the forms is discussed in these sections; only those elements that warrant additional instructions are mentioned. Nonetheless, the contractor shall – unless stated otherwise in this chapter or in another CMS directive - adhere to all instructions in this chapter 15 in terms of the collection, processing, and verification of all data elements on the Form CMS-855 applications, regardless of whether the data element in question is discussed in sections 15.5.1 through 15.5.19.7.
For purposes of these sections, and unless otherwise indicated, the term “approval” includes recommendations for approval.
B. Precedence of Sections 15.7 through 15.7.1.6.2
Though the contractor shall follow the instructions in sections 15.5.1 through 15.5.19.7, any specific processing or verification instructions in sections 15.5.7 through 15.7.1.6.2 shall – unless stated otherwise in this chapter or in another CMS directive - take precedence over those in sections 15.5.1 through 15.5.19.7.
See sections 15.7.1.3.1 and 15.7.1.3.2 for information regarding “processing alternatives.”
Practice Location Information
Unless specifically indicated otherwise, the instructions in this section 15.5.4 apply to the Form CMS-855A, the Form CMS-855B, and the Form CMS-855I.
The instructions in section 15.5.4.1 apply only to the Form CMS-855A; the instructions in section 15.5.4.2 apply only to the Form CMS-855B; and the instructions in section 15.5.4.3 only apply to the Form CMS-855I.
A. Practice Location Verification
The contractor shall verify that the practice locations listed on the application actually exist. If a particular location cannot at first be verified, the contractor shall request clarifying information; for instance, the contractor can request that the applicant furnish letterhead showing the appropriate address.)
The contractor shall also verify that the reported telephone number is operational and connects to the practice location/business listed on the application. However, the contractor need not contact every location for applicants that are enrolling multiple locations; the contractor can verify each location’s telephone number with the contact person listed on the application and note the verification accordingly in the contractor’s verification documentation per section 15.7.3 of this chapter. (The telephone number must be one where patients and/or customers can reach the applicant to ask questions or register complaints.)
The contractor may also match the applicant's telephone number with known, in-service telephone numbers - via, for instance, the Yellow Pages or the Internet - to correlate telephone numbers with addresses. If the applicant uses his/her/its cell phone for their business, the contractor shall verify that this is a telephone connected directly to the business. If the contractor cannot verify the telephone number, it shall request clarifying information from the applicant; the inability to confirm a telephone number may indicate that an onsite visit is necessary. In some instances, a 1-800 number or out-of-state number may be acceptable if the applicant's business location is in another State but his/her/its practice locations are within the contractor’s jurisdiction.
Additionally, once the verification of practice locations is complete, the contractor need not verify the address via the Internet (for example, 411.com, USPS.com, etc.). Finalist (which is integrated into PECOS) verifies the validity of an address with the United States Postal Service (USPS). Additional verification is only needed if Finalist cannot validate an actual address.
Also:
• If an individual practitioner or group practice: (1) is adding a practice location and (2) is normally required to complete a questionnaire in section 2 of the Form CMS-855I or Form CMS-855B specific to its supplier type (e.g., psychologists, physical therapists), the person or entity must submit an updated questionnaire to incorporate services rendered at the new location.
• Any provider submitting a Form CMS-855A, Form CMS-855B or Form CMS-855I application must submit the 9-digit ZIP Code for each practice location listed.
• For providers/suppliers paid via the Fiscal Intermediary Shared System (FISS), the practice location name entered into the Provider Enrollment, Chain and Ownership System (PECOS) shall be the “doing business as” name (if it is different from the legal business name). For suppliers paid via the Multi-Carrier System (MCS), the practice location name entered into PECOS shall be the legal business name.
B. Do Not Forward (DNF)
Unless instructed otherwise in another CMS directive, the contractor shall follow the DNF initiative instructions in Pub. 100-04, chapter 1, section 80.5. Returned paper checks, remittance notices, or EFT payments shall be flagged if returned from the post office or banking institution, respectively, as this may indicate that the provider’s “special payment” address (section 4 of the Form CMS-855) or EFT information has changed. The provider should submit a Form CMS-855 or Form CMS-588 request to change this address; if the provider does not have an established enrollment record in the Provider Enrollment, Chain and Ownership System, it must complete an entire Form CMS-855 and Form CMS-588. The Durable Medical Equipment Medicare Administrative Contractors are responsible for obtaining, updating and processing Form CMS-588 changes.
In situations where a provider is closing his/her/its business and has a termination date (e.g., he/she is retiring), the contractor will likely need to make payments for prior services rendered. Since the practice location has been terminated, the contractor may encounter a DNF message. If so, the contractor should request the provider to complete the “special payment” address section of the Form CMS-855 and to sign the certification statement. The contractor, however, shall not collect any other information unless there is a need to do so.
C. Remittance Notices/Special Payments
For new enrollees, all payments must be made via EFT. The contractor shall thus ensure that the provider has completed and signed the Form CMS-588 and shall verify that the bank account is in compliance with Pub. 100-04, chapter 1, section 30.2.
If an enrolled provider that currently receives paper checks submits a Form CMS-855 change request – no matter what the change involves – the provider must also submit:
• A Form CMS-588 that switches its payment mechanism to EFT. (The change request cannot be processed until the Form CMS-588 is submitted.) All future payments (excluding special payments) must be made via EFT.
• Any provider submitting a Form CMS-855A, Form CMS-855B or Form CMS-855I application must submit the 9-digit ZIP Code for each practice location listed.
• For providers/suppliers paid via the Fiscal Intermediary Shared System (FISS), the practice location name entered into the Provider Enrollment, Chain and Ownership System (PECOS) shall be the “doing business as” name (if it is different from the legal business name). For suppliers paid via the Multi-Carrier System (MCS), the practice location name entered into PECOS shall be the legal business name.
• An updated section 4 that identifies the provider’s desired “special payments” address.
The contractor shall also verify that the bank account is in compliance with Pub. 100-04, chapter 1, section 30.2.
(Once a provider changes its method of payment from paper checks to EFT, it must continue using EFT. A provider cannot switch from EFT to paper checks.)
The “special payment” address may only be one of the following:
• One of the provider’s practice locations
• A P.O. Box
• The provider’s billing agent. The contractor shall request additional information if it has any reason to suspect that the arrangement – at least with respect to any special payments that might be made – may violate the Payment to Agent rules in Pub. 100-04, chapter 1, section 30.2.
• The chain home office address. Per Pub.100-04, chapter 1, section 30.2, a chain organization may have payments to its providers sent to the chain home office. The legal business name of the chain home office must be listed on the Form CMS-588. The TIN on the Form CMS-588 should be that of the provider.
• Correspondence address
Below is a list of individuals and entities that frequently attempt to enroll in Medicare, but are not eligible to do so. If the contractor receives an enrollment application from any of these individuals or entities, the contractor shall deny the application.
• Acupuncturist
• Assisted Living Facility
• Birthing Center
• Certified Alcohol and Drug Counselor
• Certified Social Worker
• Drug and Alcohol Rehabilitation Counselor
• Hearing Aid Center/Dealer
• Licensed Alcoholic and Drug Counselor
• Licensed Massage Therapist
• Licensed Practical Nurse
• Licensed Professional Counselor
• Marriage Family Therapist
• Master of Social Work
• Mental Health Counselor
• National Certified Counselor
• Occupational Therapist Assistant
• Physical Therapist Assistant
• Registered Nurse
• Speech and Hearing Center
• Substance Abuse Facility
Sections of the Forms CMS-855A, CMS-855B, and CMS-855I
A. Background
Sections 15.5.1 through 15.5.19.7 below discuss various data elements on the Form CMS-855A, Form CMS-855B, and Form CMS-855I. Not every data element on the forms is discussed in these sections; only those elements that warrant additional instructions are mentioned. Nonetheless, the contractor shall – unless stated otherwise in this chapter or in another CMS directive - adhere to all instructions in this chapter 15 in terms of the collection, processing, and verification of all data elements on the Form CMS-855 applications, regardless of whether the data element in question is discussed in sections 15.5.1 through 15.5.19.7.
For purposes of these sections, and unless otherwise indicated, the term “approval” includes recommendations for approval.
B. Precedence of Sections 15.7 through 15.7.1.6.2
Though the contractor shall follow the instructions in sections 15.5.1 through 15.5.19.7, any specific processing or verification instructions in sections 15.5.7 through 15.7.1.6.2 shall – unless stated otherwise in this chapter or in another CMS directive - take precedence over those in sections 15.5.1 through 15.5.19.7.
See sections 15.7.1.3.1 and 15.7.1.3.2 for information regarding “processing alternatives.”
Practice Location Information
Unless specifically indicated otherwise, the instructions in this section 15.5.4 apply to the Form CMS-855A, the Form CMS-855B, and the Form CMS-855I.
The instructions in section 15.5.4.1 apply only to the Form CMS-855A; the instructions in section 15.5.4.2 apply only to the Form CMS-855B; and the instructions in section 15.5.4.3 only apply to the Form CMS-855I.
A. Practice Location Verification
The contractor shall verify that the practice locations listed on the application actually exist. If a particular location cannot at first be verified, the contractor shall request clarifying information; for instance, the contractor can request that the applicant furnish letterhead showing the appropriate address.)
The contractor shall also verify that the reported telephone number is operational and connects to the practice location/business listed on the application. However, the contractor need not contact every location for applicants that are enrolling multiple locations; the contractor can verify each location’s telephone number with the contact person listed on the application and note the verification accordingly in the contractor’s verification documentation per section 15.7.3 of this chapter. (The telephone number must be one where patients and/or customers can reach the applicant to ask questions or register complaints.)
The contractor may also match the applicant's telephone number with known, in-service telephone numbers - via, for instance, the Yellow Pages or the Internet - to correlate telephone numbers with addresses. If the applicant uses his/her/its cell phone for their business, the contractor shall verify that this is a telephone connected directly to the business. If the contractor cannot verify the telephone number, it shall request clarifying information from the applicant; the inability to confirm a telephone number may indicate that an onsite visit is necessary. In some instances, a 1-800 number or out-of-state number may be acceptable if the applicant's business location is in another State but his/her/its practice locations are within the contractor’s jurisdiction.
Additionally, once the verification of practice locations is complete, the contractor need not verify the address via the Internet (for example, 411.com, USPS.com, etc.). Finalist (which is integrated into PECOS) verifies the validity of an address with the United States Postal Service (USPS). Additional verification is only needed if Finalist cannot validate an actual address.
Also:
• If an individual practitioner or group practice: (1) is adding a practice location and (2) is normally required to complete a questionnaire in section 2 of the Form CMS-855I or Form CMS-855B specific to its supplier type (e.g., psychologists, physical therapists), the person or entity must submit an updated questionnaire to incorporate services rendered at the new location.
• Any provider submitting a Form CMS-855A, Form CMS-855B or Form CMS-855I application must submit the 9-digit ZIP Code for each practice location listed.
• For providers/suppliers paid via the Fiscal Intermediary Shared System (FISS), the practice location name entered into the Provider Enrollment, Chain and Ownership System (PECOS) shall be the “doing business as” name (if it is different from the legal business name). For suppliers paid via the Multi-Carrier System (MCS), the practice location name entered into PECOS shall be the legal business name.
B. Do Not Forward (DNF)
Unless instructed otherwise in another CMS directive, the contractor shall follow the DNF initiative instructions in Pub. 100-04, chapter 1, section 80.5. Returned paper checks, remittance notices, or EFT payments shall be flagged if returned from the post office or banking institution, respectively, as this may indicate that the provider’s “special payment” address (section 4 of the Form CMS-855) or EFT information has changed. The provider should submit a Form CMS-855 or Form CMS-588 request to change this address; if the provider does not have an established enrollment record in the Provider Enrollment, Chain and Ownership System, it must complete an entire Form CMS-855 and Form CMS-588. The Durable Medical Equipment Medicare Administrative Contractors are responsible for obtaining, updating and processing Form CMS-588 changes.
In situations where a provider is closing his/her/its business and has a termination date (e.g., he/she is retiring), the contractor will likely need to make payments for prior services rendered. Since the practice location has been terminated, the contractor may encounter a DNF message. If so, the contractor should request the provider to complete the “special payment” address section of the Form CMS-855 and to sign the certification statement. The contractor, however, shall not collect any other information unless there is a need to do so.
C. Remittance Notices/Special Payments
For new enrollees, all payments must be made via EFT. The contractor shall thus ensure that the provider has completed and signed the Form CMS-588 and shall verify that the bank account is in compliance with Pub. 100-04, chapter 1, section 30.2.
If an enrolled provider that currently receives paper checks submits a Form CMS-855 change request – no matter what the change involves – the provider must also submit:
• A Form CMS-588 that switches its payment mechanism to EFT. (The change request cannot be processed until the Form CMS-588 is submitted.) All future payments (excluding special payments) must be made via EFT.
• Any provider submitting a Form CMS-855A, Form CMS-855B or Form CMS-855I application must submit the 9-digit ZIP Code for each practice location listed.
• For providers/suppliers paid via the Fiscal Intermediary Shared System (FISS), the practice location name entered into the Provider Enrollment, Chain and Ownership System (PECOS) shall be the “doing business as” name (if it is different from the legal business name). For suppliers paid via the Multi-Carrier System (MCS), the practice location name entered into PECOS shall be the legal business name.
• An updated section 4 that identifies the provider’s desired “special payments” address.
The contractor shall also verify that the bank account is in compliance with Pub. 100-04, chapter 1, section 30.2.
(Once a provider changes its method of payment from paper checks to EFT, it must continue using EFT. A provider cannot switch from EFT to paper checks.)
The “special payment” address may only be one of the following:
• One of the provider’s practice locations
• A P.O. Box
• The provider’s billing agent. The contractor shall request additional information if it has any reason to suspect that the arrangement – at least with respect to any special payments that might be made – may violate the Payment to Agent rules in Pub. 100-04, chapter 1, section 30.2.
• The chain home office address. Per Pub.100-04, chapter 1, section 30.2, a chain organization may have payments to its providers sent to the chain home office. The legal business name of the chain home office must be listed on the Form CMS-588. The TIN on the Form CMS-588 should be that of the provider.
• Correspondence address
Hey,
ReplyDeleteThank you for sharing such an amazing and informative post. Really enjoyed reading it. :)
Apu
Medical Case Management