Author Topic: Biller - Medicare Registration/Enrollment  (Read 3042 times)

Scott

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Biller - Medicare Registration/Enrollment
« on: August 01, 2014, 06:01:48 PM »
Can someone help me with how to enroll/register with Medicare so that I am able to accept payment at my billing company on behalf of a provider?  Are there specific forms?  I assume I have to have some kind of agency/assignment agreement.

Thanks for your help

Michele

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Re: Biller - Medicare Registration/Enrollment
« Reply #1 on: August 04, 2014, 10:30:26 AM »
Billing Services do not need to enroll with Medicare but they do need to notify Medicare (well actually the provider needs to) when a billing service is being used.  Payment for Medicare services must be made directly to the provider.  A Billing Service cannot 'accept payment' on behalf of a provider.  There are also EDI forms that a billing service needs to complete to submit claims electronically.  I hope that answers your question, it was a bit confusing.  I wasn't sure if you actually meant that you wanted the payments to be made to you, or if you just meant in order to bill for providers.   :)
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Scott

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Re: Biller - Medicare Registration/Enrollment
« Reply #2 on: August 04, 2014, 10:55:46 AM »
Thanks Michele for your help.  Appreciate it.  We have the EDI side covered.  I always thought the same thing - that Medicare payments always must be made directly to the provider, but I've recently read language from CMS' Integrity Manual, section 15.5.8, that a billing agency can accept payment.  They state that "In order to receive payment directly from Medicare on behalf of a provider or supplier, a billing agency must meet the conditions described in section 1842(b)(6)(D) of the Social Security Act."  The conditions in that section are a little confusing so I wondered if some other billing company out there has already vetted this.  It sounds like I would need some kind of agency agreement.  Am I reading this all wrong?

PMRNC

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Re: Biller - Medicare Registration/Enrollment
« Reply #3 on: August 04, 2014, 01:13:07 PM »
Quote
Thanks Michele for your help.  Appreciate it.  We have the EDI side covered.  I always thought the same thing - that Medicare payments always must be made directly to the provider, but I've recently read language from CMS' Integrity Manual, section 15.5.8, that a billing agency can accept payment.  They state that "In order to receive payment directly from Medicare on behalf of a provider or supplier, a billing agency must meet the conditions described in section 1842(b)(6)(D) of the Social Security Act."  The conditions in that section are a little confusing so I wondered if some other billing company out there has already vetted this.  It sounds like I would need some kind of agency agreement.  Am I reading this all wrong?

In more simple terminology.. YES with a lock box, however I caution against this. Two reasons, with the biggest concern is liability and the second being marketability. Outsourced medical billing companies need to remember their goals of saving money but not taking control. I just prefer to have ALL checks go to the provider leaving no room for any issues. JMHO.  I also know in some states you do need surety bond to collect payments if you are thinking of that solution for non govt claims. I leave that part to collection agencies.
Linda Walker
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Michele

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Re: Biller - Medicare Registration/Enrollment
« Reply #4 on: August 06, 2014, 07:57:30 AM »
You are speaking of Medicare specifically.  Medicare no longer sends paper checks (at least that's what they say).  I'm not sure if some areas are still sending them but I don't believe they will.  When they set up the EFT the bank account must be in the provider's name.  They will not set up the EFT if another person's name is on the account other than the provider, or an authorized representative of the group.  I have had many providers who are enrolled with Medicare under their ssn and indiv NPI.  When they go to set up their EFT their spouse's name is on the checking account.  Medicare refuses to set up the EFT because someone other than the provider has access to the funds.

The ERAs on the other hand can be received by the billing service but the provider must have unrestricted access to them. 

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PMRNC

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Re: Biller - Medicare Registration/Enrollment
« Reply #5 on: August 06, 2014, 08:36:56 AM »
Linda Walker
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shanbull

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Re: Biller - Medicare Registration/Enrollment
« Reply #6 on: August 06, 2014, 09:20:06 AM »
You are speaking of Medicare specifically.  Medicare no longer sends paper checks (at least that's what they say).  I'm not sure if some areas are still sending them but I don't believe they will. 

The only circumstance under which they will issue paper checks is if an enrolled provider has not re-validated yet since March 25, 2011:

Quote
Existing regulations at 42 CFR 424.510(e)(1)(2) require that at the time of enrollment, enrollment change request or revalidation, providers and suppliers that expect to receive payment from Medicare for services provided must also agree to receive Medicare payments through electronic funds transfer (EFT). Section 1104 of the Affordable Care Act (ACA) further expands Section 1862 (a) of the Social Security Act by mandating federal payments to providers and suppliers only by electronic means.
(from my MAC's EDI page)

New enrolling providers and providers who are revalidating for the first time since March 25, 2011 have no option besides EFT.

Scott

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Re: Biller - Medicare Registration/Enrollment
« Reply #7 on: August 06, 2014, 11:07:14 AM »
Thanks for all the information.  It is very helpful and sounds like I don't want to be involved in receiving the funds.  My background is pharmacy billing for physicians where all funds come to me first.  So, it was what I was used to.  Thanks again.

Scott

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Re: Biller - Medicare Registration/Enrollment
« Reply #8 on: August 06, 2014, 11:30:11 AM »
Linda, I read your link, which I found to be very helpful.  One thing that I picked up on is that if I wanted to be the agency receiving the funds, I could not charge the provider a percentage of collections.  Does the rule where I can't, as the billing agency, charge a percentage of collections apply if the money goes to the provider?  It's a little confusing to me as to how I can charge my clients for billing Medicare.

shanbull

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Re: Biller - Medicare Registration/Enrollment
« Reply #9 on: August 06, 2014, 11:31:46 AM »
Linda, I read your link, which I found to be very helpful.  One thing that I picked up on is that if I wanted to be the agency receiving the funds, I could not charge the provider a percentage of collections.  Does the rule where I can't, as the billing agency, charge a percentage of collections apply if the money goes to the provider?  It's a little confusing to me as to how I can charge my clients for billing Medicare.

Not necessarily, it depends on your state's rules. Some states do not allow percentage billing, some do. The other option is to charge a flat fee, either per claim or time-based.

Medicare itself has not banned percentage billing when the money goes to the provider.
« Last Edit: August 06, 2014, 11:33:34 AM by shanbull »