General Category > General Questions
Biller - Medicare Registration/Enrollment
Scott:
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:
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. :)
Scott:
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:
--- 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?
--- End quote ---
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.
Michele:
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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