Webinar
February
13, 2007
Topic: Tips on Completing
Provider Enrollment Application
Questions & Answers
Contractor
General Comment: Please note that the transcript of these
questions was edited to allow for the greatest dissemination of information to the
widest audience. For more information
including Tips to Facilitate the Enrollment Process, the Enrollment
Applications and Frequently Asked Questions, please visit the CMS website at: http://www.cms.hhs.gov/MedicareProviderSupEnroll/
Question 1: Will all demand
letters identify all errors to be corrected and will all Medicare representatives
be consistent in their review of the Application? (Note: Demand letter was used incorrectly in the
program. The letter is a development
letter.)
Answer 1: The letters should identify all missing information that is
needed. All associates are trained to request the same information.
_________________________________________________________________________
Question 2: If the TIN is the
only change, is it necessary to complete the entire 855B for a Psych Group and
must all physicians in the group complete an 855R?
Answer 2: Yes, if you have a new TIN, a complete 855B must be
completed, as well as 855Rs for all employees.
_________________________________________________________________________
Question 3: What date would be
the latest date on the 855B (lower left hand corner)?
Answered: 04/06
Updated Answer: 06/06
_________________________________________________________________________
Question 4: Would you show the
E-Learning web address again please?
Answer 4: http://www.medicarenhic.com/providers/online/providerEnrollment/slides.asp
_________________________________________________________________________
Question 5: Is the green resubmission
form a new document? or We have not seen a green
resubmission form yet...what is the effective date?
Answer 5: The green form is new, and is only used in CA.
_________________________________________________________________________
Question 6: Are there phone
contacts for California Provider Enrollment?
Answer 6: Customer Service can be reached at 877-527-6613
Updated Answer: The contact for
Provider Enrollment is Customer Service.
However, please note that the instructions relating to the applications
are in the application forms themselves.
Customer Service is unable to
tell you the status of your application until the process time has elapsed.
Please see Q&A #66 for the process times and Q&A #68 for additional
information.
CA Customer Service may be reached at 877-527-6613. MA Customer Service may
be reached at 877-527-6594. ME, NH & VT Customer
Service may be reached at 877-258-4442
_________________________________________________________________________
Question 7: What if we do not
know what the original information submitted is?
Answer 7: You should keep a
copy of what you submit. However, if you need assistance, please contact
Customer Service.
_________________________________________________________________________
Question 8: Do we have to fill
out the 855B for a simple change of mailing address?
Answer 8: Yes. All address changes require completion of the proper
forms, or you will not receive your payments.
Updated Answer: As indicated on
the 855 Enrollment Applications, any change to your existing enrollment data
must be reported within 90 days of the effective dates of the change. Mail that is returned due to address changes
will result in payment holds.
_________________________________________________________________________
Question 9: What if the demand
letter is faxed to us and does not include a green sheet? How is that
identified by the mail room?
Answer 9: The green development
sheet is only used in CA
_________________________________________________________________________
Question 10: For an
incorporated individual (not group) which NPI number is required?
Answer 10: You will need a type 1 (individual) and a type 2 (group)
_________________________________________________________________________
Question 11: How do I get a demand
letter sent to contact person rather than provider's address?
Answer 11: We send development letters to the contact person listed
on the enrollment forms.
_________________________________________________________________________
Question 12: If a physician is
joining an existing group that already has a completed EFT Application... is
this still required for an added physician?
Answer 12: No, you do not have to submit an EFT form
if a provider is joining a group that already has EFT.
_________________________________________________________________________
Question 13: If I am adding a new
physician only to an existing location... do I check change or add for this in
4C?
Answer 13: You can leave it blank.
_________________________________________________________________________
Question 14: What forms are needed
for a provider who is already enrolled with Medicare? Why do they need to
submit an 855I in addition to the 855R? If they are already enrolled they
should not have to do an "I" only the "R" to be identified
as a rendering provider, correct????
Answer 14: Because the doctor
may still have their original number for working at their own private practice.
Each location the individual provider works at should be attached to a
different Individual Medicare PIN #
Updated Answer: The
855I is needed in addition to the 855R if the provider has not submitted an
855I since 11/2003 _________________________________________________________________________
Question 15: Does Medicare issue
provider numbers based on location? Would a provider have multiple Medicare PIN's based on each practice location?
Answer 15: If you are in the same pricing locality, then the answer
is no. If you are in a different pricing area, a new number is required.
_________________________________________________________________________
Question 16: Which date do we
need to use to determine if an 855I is required...6 yrs, 2000 or 2003? I heard
three different dates.
Answer 16: If you enrolled prior to November 2003, you will need to
submit an 855I.
_________________________________________________________________________
Question 17: Is there a check list of all forms required to
add a physician to your group provider number?
Answer 17: Yes, the check
lists are contained within the enrollment forms.
_________________________________________________________________________
Question 18: Is there a list of the forms required for
adding physicians? I was unaware of the
new forms that were required since 2006 when filling out our application and it
significantly delayed the process for adding our physician.
Answer 18: The required forms are identified in the enrollment
applications. For additional information on what forms are required, please see
the Tips to Facilitate the Medicare Enrollment Process published on the
CMS website at http://www.cms.hhs.gov/MedicareProviderSupEnroll/downloads/Enrollmenttips.pdf______________________________________________________________________________
Question 19: What forms would be
needed if an individual provider hires a physician (that already is a Medicare
provider at a different address) to work in the office 1 day a week?
Answer 19: One 855-I and one 855-R
Updated Answer: If the provider
hired was enrolled prior to 11/2003 and the different address is within the
same payment locality, only an 855R may be required.
_________________________________________________________________________
Question 20: I work for an
individual provider who will be hiring a physician to work 1 day a week in the
office. Would the individual provider need to fill out an 855B in order for the
new physician to assign benefits over with the 855R?
Answer 20: Yes, a group needs to be formed under a tax ID for the new
physician to reassign benefits.
Updated Answer: The employee would submit the 855I if new or
has not submitted an application since 11/2003, plus the 855R. _________________________________________________________________________
Question 21: What if the group
does not have an EFT; what should the provider do joining the same group?
Answer 21: If the group is already established and you are just
joining, they do not need to sign up for EFT.
_________________________________________________________________________
Question 22: Who could be a
"managing" individual?
Answer 22: It can be a W-2 employee.
Updated Answer: The definition
for managing employee is included in the CMS Enrollment Applications. Managing
employee means a general manager, business manager, administrator, director, or
other individual who exercises operational or managerial control over, or who
directly or indirectly conducts, the day-to-day operations of he supplier,
either under contract or thorough some other arrangement, regardless of whether
the individual is a W-2 employee of the supplier.
_________________________________________________________________________
Question 23: Our office has gone
through a few office managers, how do we find out who our authorized signature
is? This has caused our applications to be returned.
Answer 23: The best option for you is to complete the sections on the
855B to designate a new authorized representative that will be signing the
855Rs. Also, send a letter requesting Medicare to delete all other authorized
officials not listed in this application.
_________________________________________________________________________
Question 24: What attachments are
required when revalidating Medicare enrollment information for a group?
Answer 24: All applicable attachments are listed in the enrollment
forms.
_________________________________________________________________________
Question 25: If we are only
revalidating information which box do we check off if we are not changing, adding
or deleting? or We were asked to revalidate our group
enrollment information. Which box do we check off if we are not changing,
adding or deleting?
Answer 25: There is no need to revalidate at this time.
_________________________________________________________________________
Question 26: Why do you need the 855 I?
Answer 26: The 855-I is for individual providers to join, change or
delete enrollment in Medicare.
_________________________________________________________________________
Question 27: I still don't
understand why I need an 855I when adding an existing Medicare provider to our
group.
Answer 27: Unless the provider is 100% completely turning all
benefits over to your group, then (and only then) would you not need to submit
an additional 855-I
Updated Answer: If an existing Medicare
provider (one who already has a Medicare PIN) is just reassigning benefits to a
group, only a CMS 855R is needed. If the provider has not submitted an
application since 11/2003 the 855I is required.
_________________________________________________________________________
Question 28: We have a new tax id
number. Do we list the effective date in the change box of the 855B?
Answer 28: You need to complete the application as if you are a new
provider. Complete the application in its entirety.
_________________________________________________________________________
Question 29: When filling out the
application as a new provider, do we have to enter any dates in the change or
add boxes?
Answer 29: No.
_________________________________________________________________________
Question 30: It's often difficult to get the doctors to
sign; if they sign in black ink instead of blue do you send it back to them and
make them sign it in blue?!?
Answer 30: No we will not. We
just ask for blue ink because it is easier to identify as an original
signature. Black ink is acceptable
_________________________________________________________________________
Question 31: Referring to 855I
and 855B, do we have to have a delegated official sign if the doctors are
signing and doing the application?
Answer 31: On the 855B,
the delegated or authorized official must sign. On the 855I, the provider must
sign.
_________________________________________________________________________
Question 32: Do you have
applications that can be filled out on-line or software to convert the .pdf format of the 855I & 855R?
Answer 32: No, it is not yet available.
Updated Answer: The CMS-855
Medicare enrollment applications are available in PDF fillable
format. This format allows a user to complete an application using Adobe
Acrobat or download and complete.
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Question 33: For a new group
application (855B), an IRS CP 575 form is requested. If not available, what
other IRS form may be used?
Answer 33: Any paper from the IRS that has the IRS logo printed on
it. Tax payment booklet forms are one possibility. The letter or form must be
one that was sent to the provider directly from the IRS.
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Question 34: If pending a group
number (885B was submitted) should we wait for approval before mailing 855B and
885R for the rendering providers?
Answer 34: All forms should be mailed together.
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Question 35: We have 67 locations
in NY State, for the 588 would I need 67 voided checks or deposit slips? I have
called and been told that a copy of the financial institute would be accepted
Answer 35: If the payment is all under 1 tax ID, 1 is sufficient.
Updated Answer: Question 35
relates to a DME Supplier. NHIC, Corp is the Medicare Part B Contractor for CA,
MA, ME, NH & VT and the DME Medicare Administrative Contractor for CT, DE,
DC, ME, MD, NH, NJ, NY, PA, RI & VT. Today’s Webinar applies to Medicare
Part B providers in CA, MA, ME., NH & VT.
Questions relating to the CMS 855S Supplier Enrollment Form and the CMS
588 EFT forms that may be needed by DME, please contact the National Supplier
Clearinghouse at 1-866-238-9652 or http://www.palmettogba.com/
_________________________________________________________________________
Question 36: For the application forms not applicable to
our office, do we leave it blank, add n/a or don't
submit with the application?
Answer 36: Leave blank.
_________________________________________________________________________
Question 37: Is the W-2 required
for the managing employee as a delegated official?
Answer 37: You do not need to submit it, but the employee must be in
a W2 status. We will request it only if we need it after review of the
application.
_________________________________________________________________________
Question 38: In Section 5 of the application, do we re-enter the company
name (corporation)? The supplier and organization would be the same.
Answer 38: Leave blank
_________________________________________________________________________
Question 39: When did NHIC
start allowing the NPPES Screen print--we have had resubmission requests when
we tried that.
Answer 39: July 2006.
_________________________________________________________________________
Question 40: We have frequent
problems of missing letters. How can we assure that letters are sent to the
billing address and not to a hospital location?
Answer 40: Correspondence is sent to the address we have on file for
your group/physician/organization.
Updated Answer: The letters are
sent to the special payments address indicated on the application (e.g. Section
4 of CMS 855I).
Question 41: On the 588 form is
the contact person the bank person or the authorized signer?
Answer 41: The contact person is any person the authorized agent wants
us to contact for any additional information. .
_________________________________________________________________________
Question 42: Why can't we speak
to provider enrollment directly? Often, customer service has to email provider
enrollment, and get back to us.
Answer 42: Customer Service is your contact for enrollment questions.
_________________________________________________________________________
Question 43: We have been told
that we can not put "pending" on the 855R when the 855B is in
process.
Answer 43: This is
acceptable.
_________________________________________________________________________
Question 44: Why if there is a "contact" person
on the 855 forms they can not get information on the application i.e.: when the
number is issued; what that number is?
Answer 44: The contact is only for the enrollment process if we need
to contact someone. After that, it must be the provider or authorized official.
_________________________________________________________________________
Question 45: When adding a nurse
practitioner to an incorporated practice, what application should we use?
Answer 45: If the NP already has a PIN, then only the 855R. If the NP does not have a
PIN, then both the 855I and 855R. An 855I is needed if the provider has
not submitted an application since 11/2003
_________________________________________________________________________
Question 46: I've had issues when adding a new physician to
an IDTF. I've submitted the 855B and the
855I's and 855R's. I then get notification from the person processing the 855B
that the physicians that I'm adding are not enrolled with Medicare. It seems as
if the applications are being separated? Any suggestions?
Answer 46: You need to complete 855B, attachment 2, and 855I and R. Make sure they are submitted together.
_________________________________________________________________________
Question 47: Explain the difference
between section 4B 1 and 2 on 855I.
Answer 47: Section 4B1 is only used if you are joining a group and
will not have a private practice.
_________________________________________________________________________
Question 48: I cannot print the
slides. I’m using the web console and cannot print the slides
Answer 48: Go to File in the left hand corner, then hit print to PDF.
If you do not have File or are unable to print, contact your education
representative for a copy of the presentation.
_________________________________________________________________________
Question 49: Could we get a
Certificate of Attendance for this Webinar?
Answer 49: We do not have certificates for attendance.
_________________________________________________________________________
Question 50: Will the CMS Enrollment
Applications be changing due to NPI Implementation?
Answer 50: No
_________________________________________________________________________
Question 51: Should the provider information go in section
6 of the 855B if the doctor maintains the office alone?
Answer 51: Yes
Question 52: If a new tax id,
should Add, Change of Delete be checked on 855B?
Answer 52: If new entity, leave
blank.
_________________________________________________________________________
Question 53: When adding locations to 855B, letters are
received requesting 855Is and 855Rs. Why?
Answer 53: When an 855B is
received, an 855I or 855R must be included.
Updated Answer: We need to know
which doctors will be working at the new location.
_________________________________________________________________________
Question 54: If a group number
has not been issued, what should be entered in group # field on 855R?
Answer 54: Write in “Pending
Group #”.
_________________________________________________________________________
Question 55: How many providers are needed to form a
group?
Answer 55: One
_________________________________________________________________________
Question 56: Will provider
numbers go away now that NPIs exist?
Answer 56: The numbers will still
exist but it is unknown if they will be communicated.
_________________________________________________________________________
Question 57: Will a new number be issued if a group adds a
location?
Answer 57: If the additional location is in the same
locality/same Fee Schedule area, a separate number will not be issued.
_________________________________________________________________________
Question 58: If changing a tax id
# for a psychiatric group, are 855B, NPI and 855R needed?
Answer 58: Yes and an 855I if the
provider has not submitted an application since 11/2003.
Updated Answer: In addition to
the answer listed, the following forms may apply.
_________________________________________________________________________
Question 59: Do we need to enroll
rendering providers if they are at different practice sites? Is an 855R for
each practice site required?
Answer 59: Yes
Updated Answer: Yes, but only if
the group has different provider numbers at each site. _________________________________________________________________________
Question 60: Do we still need to complete
a Medicare Enrollment packet now that NPI is in place?
Answer 60: Yes.
_________________________________________________________________________
Question 61: Is there a specific time frame that a new
enrollee with a NPI has to enroll with Medicare?
Answer 61: If Medicare
patient-Enroll.
Updated Answer: You would want to
enroll as soon as you see your first Medicare patients to prevent possible
denial due the claim not being submitted timely.
_________________________________________________________________________
Question 62:
One provider. Incorporated with DBA. Is 855I or
855B submitted?
Answer 62: 855I for Provider Name and 855B for Group
Name
Updated Answer: If the provider
is using their first and last name an 855I should be completed. If the provider is using a fictitious name the 855B, 855I if new or
has not submitted an app since 11/2003 and the 855R.
_________________________________________________________________________
Question 63: If deactivated from
group, is only an 855R needed?
Answer 63: Yes
_________________________________________________________________________
Question 64:
Clarification on deactivation. If a provider for many years but may have
not billed, does group provider submit 855I and 855R?
Answer 64: If Enrollment was done
5 years ago, 855I and 855R needed. If Enrollment was done 2 years ago, just
855R needed.
Updated Answer: If the provider has not submitted an
application since 11/2003 an 855I and 855R must be submitted.
Question 65: What
is definition of delegated official and managing employee?
Answer 65: An
authorized official is the highest person in organization. A delegated official
can be a managing employee who can authorize.
Updated Answer:
The definitions for Authorized Official, Delegated Official and Managing
Employee may be found in Sections 6 and 15 of the CMS 855B and 855 I enrollment applications. The definitions of terms commonly used in the
Medicare enrollment process may be found on the CMS website at: http://www.cms.hhs.gov/MedicareProviderSupEnroll/downloads/Terms.PDF
_________________________________________________________________________
Question 66: What
is time frame for processing applications?
Answer 66: Changes are usually processed in 60 days. If a
new provider or group, applications are usually processed in 180 days.
Updated Answer: For
changes of information we have 90 days to process the application; for initial
applications we have 180 days to process. _________________________________________________________________________
Question 67: If
only working at hospital and fully licensed, what forms need to be submitted?
Answer 67: Enroll
with 855R and EFT with Group Name.
Updated Answer: If a provider is employed by a hospital and
will be rendering Part B services billable to the Contractor, the provider
would submit the standard enrollment forms (855I, 855R, and possibly Medicare
Participating Agreement.
_________________________________________________________________________
Question 68: When
checking on status of applications with Customer Service, what should be said
to get most accurate information. For instance, if new doctor and 855I with
SS#, I usually wait 2 weeks before calling.
Answer 68: There
is no need to call Customer Service until processing time has passed. Once an application is received, it is screened.
If an application needs to be developed, you will hear directly from Provider
Enrollment staff. Customer Service may
not be able to tell you the status of your application while it is being
processed, as it will may change as it goes through
the process.
_________________________________________________________________________
Question 69: What should be submitted in section 4 if
rendering services in patient homes and one town has 4 zip codes?
Answer 69: If you
are rendering services in a certain county, list zip
code range for county.
Updated Answer: According to the instructions listed in
section 4C of the CMS 855I, “If you only render services in patients’ homes,
you may supply your home address in this section if you do not have an office.
In Section 4H; explain that this address is for Administrative purposes only and
that all services are rendered in patients’ homes”.
_________________________________________________________________________
Question 70: Clarification.
Is only an 855R needed to reactivate? I
submitted an application a year and half ago and have been told to submit 855I
and 855R to reactivate.
Answer 70: If enrolled prior to November 2003, 855I is
needed. It is best to submit both. The 855I has a reactivation box.
_________________________________________________________________________
Question 71: What
is the difference between delegated and authorized? Our group has 7
owners/physicians and no current practice manager. I was told that only a delegated
person can sign applications.
Answer 71: If the
signature is not on file, section 6 must be completed.
Updated Answer: Section
15 of the CMS 855 Enrollment application should guide you on who can sign the
applications.
3/08/2007