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Enrolling as a Medicare Provider

If you will be seeing Medicare patients, you will need to enroll as a Medicare provider. We’ll take you through the process, step-by-step:

1. Obtain a National Provider Identifier (NPI). The NPI is a unique 10-digit identifier that will stay with you throughout your career. If you are a sole proprietor, you will need only one NPI.

If you are forming a corporation or LLC, you will need an NPI for yourself (Type 1) and for your business (Type 2). There is no charge to you to apply for an NPI number.

You can complete an online application the NPPES Web site (https://nppes.cms.hhs.gov/NPPES/Welcome.do). Follow the instructions carefully.

Note that you will need your chiropractic license before you can complete the NPI. If you have correctly completed the application, you may receive your NPI number within 10 days. If you don’t want to apply online, you can download a paper application and mail it in. Go to www.cms.hhs.gov/NationalProvIdentStand/ for the form,

You will need to include your NPI number on all Medicare claims and all other correspondence with Medicare. By May 23, 2007, all Medicare providers will be required to have an NPI number, so you may as well apply as soon as you get your license.

2. Complete form CMS-855. After you have received your NPI, you must then complete the appropriate Medicare provider enrollment form (CMS-855). If you are a sole proprietor, you’ll use the 855i form .

If you are any other entity, you’ll use the 855b form. (Note that you must have your NPI in order to complete the CMS-855 form. Medicare contracts with various independent contractors who provide enrollment and billing services.

Your CMS-855 form must be submitted to the appropriate carrier (the entity that processes enrollment applications), depending upon your state. Carriers are listed on the “Medicare Fee-for-Service Provider Enrollment Contact List” available on the CMS Web site.

It is a very good idea to fill out the CMS-855 (I or B) and then call the carrier and have someone walk you through the application to be sure it is filled out correctly. This will save a lot of time and frustration in getting your enrollment completed and beginning to obtain reimbursement from Medicare. If everything is correct and complete on your application, your application may be processed within 60 days.

3. Choose your provider status. Your next decision will be whether to enroll as a participating provider or a nonparticipating provider. Participating providers agree to accept Medicare reimbursement as their payment, and they cannot bill additional amounts to Medicare patients. Why participate? Because:

• Medicare reimbursement is 5 percent higher for participating doctors than non-par doctors,

• Medicare pays participating doctors directly,

• Claim information is forwarded to Medigap insurers (who provide additional coverage to Medicare patients).

Many chiropractors do not participate in the Medicare program. If you decide you do want to participate, you must complete a “Medicare Participating Physician or Supplier Agreement” (Form CMS-460).

Medicare provides some tips to help you through the enrollment process on its Medicare Provider-Supplier Enrollment Web page.

Some of the most important tips:

  • Be sure you are using the most recent (2006) enrollment application.
  • Submit the correct application for your provider type to the correct contractor serving your state or location. (See above for the link to the list, and note that, as a physician, you are looking for the carrier designation.)
  • Be sure your application is complete. Fill out every single section, using “N/A” for sections that do not apply to your situation, and use BLUE ink.
  • You must have your NPI number before you can submit the enrollment application.
  • Be certain that you have signed and dated the forms, preferably in blue ink.

 

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