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
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
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
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?
• Medicare reimbursement is 5 percent
higher for participating doctors than non-par doctors,
• Medicare pays participating doctors
• Claim information is forwarded to
Medigap insurers (who provide additional coverage to Medicare
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
- Be certain that you have signed and dated the forms, preferably
in blue ink.