Author Topic: New To Medicare  (Read 1304 times)

lacycr

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New To Medicare
« on: June 26, 2018, 08:09:59 PM »
I am working at a medical office and have been doing chiropractic billing for several years. My doctor is non par with medicare and since our demographic is younger athletes and sports medicine, we've never had to do billing for any medicare as again, its not our main demographic.

Now for the part I need help with...we are expanding our services and added a second location as well, we have a new business name/tax id/npi etc. so our new drs we hired are working under that new information. we have hired a physical therapist who IS participating with medicare and wants to see medicare patients. when contacting Noridian, they told me to login into the PECOS system to manage the reassignment and to add our new PT to our office and then once processed we can begin billing for him. However when looking to do that, one of the question is "Is the individual or group who is receiving the applicants benefits enrolled in Medicare?" Is that asking if our organization is enrolled with medicare? If we are not, then can I enroll us mid year like this? I think I remember reading there is an enrollment period. If we enroll the organization, can only that dr be participating and the others be non par? or do they have have to be par?

Sorry if that's confusing! I'm new to medicare and want to make sure I get it set up correctly. Thanks for any help!

Michele

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Re: New To Medicare
« Reply #1 on: June 27, 2018, 01:17:19 PM »
There is no enrollment period for providers, they can enroll anytime.  The enrollment period is for beneficiaries. 

You need to enroll the group as a Provider and then link the PT to the group using a CMS 855R (or through PECOS as a re-assignment).

If the PT is already enrolled in Medicare you only need to do the CMS 855R or re-assignment, if they are not you would need to enroll them as an individual and also do the re-assignment.

I hope that helps!
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lacycr

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Re: New To Medicare
« Reply #2 on: June 27, 2018, 01:47:14 PM »
Thanks Michele! That is helpful. I wanted to clarify one thing. The PT is already enrolled in Medicare. When I looked at the CMS 855R form, it states "both the individual practitioner and the eligible organization/group must be currently enrolled in Medicare program before reassignment can take effect." So I do need to enroll our group (using group NPI?) in Medicare first then do the re-assignemtn for our PT?

If so, since the group will be participating, will all drs then have to be par? or can they still choose to be nonpar? That's the part that confuses me.

Thank you again!

Sriram_Sub

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Re: New To Medicare
« Reply #3 on: June 29, 2018, 09:49:09 AM »
Hi Lacyr,

The group enrollment does not need you to have all the individuals participate with Medicare as a mandate. You may have individuals who wish not to participate with the payer too. It's just those individuals won't get paid if they treat medicare patients. In your case, the PT is already Par with Medicare. So, as Michele stated, a CMS-855B for the group enrollment, a CMS-460 for the participating provider agreement, a CMS-588 for the EFT agreement and a CMS-855R for reassigning the PTs benefits to the group would suffice.

Just so you know, Medicare would do a site visit for audit before approving the group application. Therefore, make sure you list all the service locations on the application form especially the one where the PT would practice. Hope this helps. Good luck.
Sriram

Michele

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Re: New To Medicare
« Reply #4 on: June 29, 2018, 04:35:16 PM »
But if you want the group to be paid for the PTs services then you need to enroll the group.  If you are completing a group application the 855R can be done at the same time.  Even though the group is not yet enrolled in Medicare, they are completing an app and that's all that matters.
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Re: New To Medicare
« Reply #4 on: June 29, 2018, 04:35:16 PM »