Medical Billing Forum

General Category => New! => Topic started by: dblakelarde on July 23, 2012, 12:58:32 PM

Title: Medicare Reactivation
Post by: dblakelarde on July 23, 2012, 12:58:32 PM
Hello,

I ran into a provider that had some CMS/fraud issues and is in need to reestablishing Medicare relationship. He has an hearing set up within the next month by phone with CMS regarding the issue. However, he's been told by CMS customer service and credentialing office that he can complete the enrollment form, however, he hasn't been officially told by the closings of his hearing. He wants to submit claims for payment. I am under the impression, that generally, yes he needs to complete enrollment forms to reactivate his provider number, NPI, etc but in order to actually submit claims, he would have to obtain a final ruling, is this correct? Also, he states that he was told by CMS that claims prior to the exclusion can be submitted, is this correct?

Your assistance will be most helpful!!

Thank you,

Dawn
Title: Re: Medicare Reactivation
Post by: dblakelarde on July 23, 2012, 06:57:20 PM
Ok, the newbie can't get a response...smiling.

Additional information...The provider pushed for me to complete his 855I forms and we did. The provider has a hearing with CMS next month..keep in mind. I recv'd copied letter from provider from CMS regarding his app. I hadn't had a provider denied enrollment so please be patient with me.

The states: We received your medicare enrollment applctions (s) 855i on x-x 2012. We are closing thi request for the following reason(s):

Providers and suppliers (except DMEPOS suppliers) can enroll in the Medicare program using either the:

1. Internet based provider enrollment......

2. Paper application process.........

you should return the complete paper application9s) to:.....


so my questions...what is the reason for closin or denying his application?
Title: Re: Medicare Reactivation
Post by: DMK on July 24, 2012, 10:26:23 AM
Sorry no one responded to you.  I think most of us don't have the answer.  It has nothing to do with being a Newbie, as we all were at one time. 

My best guess is that he can submit bills only for dates of service rendered while he was an approved provider.  (That should have already been done, I'm guessing these are re-bills?) 

There is no guarantee that they will approve his re-application.  If he's currently treating Medicare patients I'm fairly certain that the patients need to be informed that he's not CURRENTLY a Medicare provider, and any services rendered while he is NOT a Medicare provider can not be billed to Medicare.  Even if he gets approved, it will most likely NOT be retroactive, it will be from a certain date forward.

It is good that the application is in process, so if they do approve it, you're ahead of the game.
Title: Re: Medicare Reactivation
Post by: PMRNC on July 24, 2012, 11:57:37 AM
Currently until he is formerly reinstated he cannot submit any charges nor see Medicare patients at all. He also cannot complete enrollments until after, not sure why they told you he could because enrollment is only for those "qualified" provider's eligible to bill medicare, and since he is not at this time, he cannot submit enrollment. Maybe they said to have the enrollment ready for submission?   And no he will not be able to submit claims retroactively either, far as I know he should not have been treating Medicare patients if he was sanctioned (you don't state exactly what reason they de-enrolled/de-activated him)
Title: Re: Medicare Reactivation
Post by: Michele on July 25, 2012, 09:29:18 AM
Just as a note, we do try to answer all and we try to do that within 24 hours.  You only gave us 6 hrs.  We do all this at no charge.
Title: Re: Medicare Reactivation
Post by: PMRNC on July 25, 2012, 09:40:28 AM
Quote
Just as a note, we do try to answer all and we try to do that within 24 hours.  You only gave us 6 hrs.  We do all this at no charge.

What?? FREE??? SHUT THE FRONT DOOR.... :) :) :)  :o ;D :)