855B Enrollment & Policy Overview

Transcription

1 855B Enrollment & Policy Overview Joanne M. Lucas, J.D., Business Function Lead CMS Andrea King, Education Specialist Novitas September 2017

2 Session Overview Examine who should complete the CMS-855B Provide a comprehensive overview of the CMS-855B application and the PECOS equivalent Explore the benefits of PECOS vs paper-based application Analyze Ownership and Managing Control; Organizations and Individuals Review Medicare enrollment of IDTFs, ASCs, and Ambulance companies 2

3 What is the 855B? The CMS form used for the enrollment of Clinic/Group practices and Certain Other Suppliers. This form is also used to submit changes to your enrollment data. 3

4 Benefits of using PECOS vs. Paper We encourage you to use PECOS instead of paper Medicare enrollment applications Advantages of using PECOS include: Completely paperless process, including electronic signature and digital document feature Faster than paper-based enrollment Tailored application process, meaning you only supply information relevant to your application and specialty More control over your enrollment information, including reassignments Easy to check and update your information for accuracy Less staff time and administrative costs to complete and submit enrollment to Medicare 4

5 Getting Started The CMS-855B Application You can find the paper application at the following link: MS-Forms/CMS- Forms/downloads/cms855b.pdf 5

6 Who should complete the CMS-855B or the PECOS equivalent? Clinic/Group practices Ambulance Service Supplier Ambulatory Surgical Center Independent Diagnostic Testing Facilities Portable X-Ray Supplier Hospital or medical practice that may bill for Medicare part A services but will also bill for Medicare part B practitioner services Currently enrolled with a Medicare FFS contractor but need to enroll in another FFS contractor s jurisdiction Currently enrolled in Medicare and need to make changes to your enrollment data 6

7 Section 1A Basic Information Reason for Application 7 BE SURE TO INCLUDE YOUR NPI AND MEDICARE IDENTIFICATION NUMBER, IF ISSUED, ON THE APPLICATION!

8 Section 1B Basic Information (Continued) All applicants must complete this section If you are Changing, Adding, or Deleting Information, a Change of Information should be submitted 8

9 Section 2A - Identifying Information Type of Supplier If you are more than one type of supplier, you MUST submit a separate application for each type. Additionally if you change the type of service that you provide, you must also submit a new application. 9

10 Section 2B1 Business Information If there is another name that the provider uses (e.g., a former legal business name, a DBA or doing business as name, etc.), then this should be listed under Other Name and check the appropriate box. 10

11 Section 2B2 State License Information 11

12 Section 2B3 Correspondence Address Contact Information is VERY important because this is where the MAC will be sending important letters and documents directly to the provider! 12

13 Section 2C - Hospitals Only If you are a hospital that plans to bill separately for each hospital department, ensure you separately list each department, Medicare identification number, and NPI. 13

14 Section 2E Physical Therapy (PT) and Occupational Therapy (OT) Groups Only If any of the responses to the listed questions is yes, then you must submit a copy of the lease agreement that gives the group exclusive use of the facility for PT/OT services. 14

15 Section 2F Accreditation for Ambulatory Surgical Centers (ASCs) Only 15

16 Section 2G Termination of Physician Assistants (Only) 16

17 Section 2H Advanced Diagnostic Imaging (ADI) Suppliers 17

18 Section 3 Final Adverse Legal Actions/Convictions 18

19 Section 3 Final Adverse Legal Actions/Convictions 19

20 Section 3 Final Adverse Legal Actions/Convictions (Continued) 20

21 Section 4A Practice Location Information Practice Location Effective Date 21

22 Section 4A Practice Location Information Provide the specific street address as recorded by the U.S. Postal Service. Do not furnish a P.O. Box number. Be sure to enter the Medicare identification number and NPI, if issued. 22

23 Section 4B Where do you want Remittance Notices/Special Payments Sent? Anyone enrolling in Medicare or changing information on their enrollment file must use an EFT. (CMS-588 FORM) 23

24 Section 4C Where Do You Keep Patients Medical Records? P.O. Boxes and Drop Boxes are not acceptable to list as where the records are maintained! 24

25 Section 4D Rendering Services in Patients Homes 25

26 Section 4E Base of Operations Address for Mobile or Portable Suppliers The base of operations is the location from where personnel are dispatched, where mobile/portable equipment is stored, and when applicable, where vehicles are parked when not in use. 26

27 Section 4F- Vehicle Information If more than two vehicles are used, copy this section and complete it for each additional vehicle. 27

28 Section 4G Geographic Location for Mobile or Portable Suppliers Base of Operations 28

29 Section 5 Ownership Interest and/or Managing Control Information Organizations 29

30 Section 5, Organizations Only All organizations that have any of the following must be listed in section 5A of the Form CMS-855: A 5 percent or greater direct or indirect ownership interest in the provider Mortgage or security interest Managing control of the provider or supplier Any general partnership interest in the provider, regardless of the percentage (For limited partnership, any interested greater than 10%) 30

31 Financial Control Defined Financial control exists when: An organization or individual is the owner of a whole or part interest in any mortgage, deed of trust, note, or other obligation secured (in whole or in part) by the provider or any of the property or assets of the provider; and The interest is equal to or exceeds 5 percent of the total property and assets of the provider. 31

32 Managing Control of The Provider or Supplier A managing organization is one that exercises operational or managerial control over the provider; Or conducts the day-to-day operations of the provider The organization need not have an ownership interest in the provider 32

33 Examples of Managing Organizations Corporations Partnerships and limited partnerships Limited liability companies Charitable and religious organizations Governmental/tribal organizations Medical staffing companies Banks and financial institutions Investment firms Holding companies Trusts and trustees Medical providers/suppliers Consulting firms Management services companies Non-profit entities 33

34 Section 5A Organization Identification Information 34

35 Section 5B Ownership Interest and/or Managing Control Information (Organizations) 35

36 Section 6 Ownership Interest and/or Managing Control Information (Individuals) 36

37 Section 6B Ownership Interest and/or Managing Control Information (Individuals) 37

38 Section 6, Individuals Only Who should be reported: Persons with 5 percent direct or indirect ownership interest Financial Control: Whole or part interest in any mortgage, deed, trust, note, and property assets ; and The interest is equal to or exceeds 5 percent of total property and assets 38 Officers and Directors Managing employees Individuals with Partnership Interest Authorized Officials Delegated Officials

39 Authorized Officials Authorized Officials must be: 5 percent direct owner of provider or supplier Have ownership interest or control of provider or supplier as: President General partner Chairman of the board Chief financial officer Chief executive officer Must be reported in Section 6 and 15 39

40 Delegated Officials Delegated individual authorized to report: Enrollment changes Sign revalidation applications Has ownership or control interest or be W-2 managing employee Managing Employee: General Manager Business Manager Administrator Operational or Managerial control over operations Must be reported in Section 6 and 16 40

41 Section 8 Billing Agency Information Applicants that use a billing agency must complete this section A billing agency is a company or individual that you contract with to prepare and submit your claims. If you use a billing agency, you are responsible for the claims submitted on your behalf 41

42 Section 13 Contact Person If questions arise during the processing of this application, the fee-for-service contractor will contact the individual shown below. 42

43 Important Takeaways Regarding Contact Person(s) If you have multiple contact persons listed, the first contact person will be notified if any additional information is needed If no contact person is listed, the provider will be contacted directly if any information is needed 43

44 Certification Statement (Section 15 and 16) Faxed, Photocopies, or stamped signatures are not considered original! 44

45 Section 15 Certification Statements Authorized Officials 45

46 Section 16 Certification Statements Delegated Officials 46

47 Section 17 Supporting Documents Failure to submit the required documentation will result in the immediate return in your enrollment application or a delay in processing the application. Mandatory for all provider/supplier types 47

48 Attachment 1 Ambulance Service Suppliers Section A Geographic Area 48

49 Attachment 1 Section B State License Information 49

50 Attachment 1 Section C Paramedic Intercept Services Information 50

51 Attachment 1 Section D Vehicle Information 51

52 Attachment 2 Independent Diagnostic Testing Facilities (IDTF) Section A Standard Qualifications 52

53 Attachment 2 Section B CPT-4 and HCPCs Codes 53

54 Attachment 2 Section C Interpreting Physician Information 54

55 Attachment 2 Section D, Personnel Who Perform Tests 55

56 Attachment 2 Section E, Supervising Physician 56

57 Attachment 2 Section E Other Physician Sites 57

58 Attachment 2 Section E Attestation for Supervising Physicians 58

59 PROGRAM INTEGRITY MANUAL CMS Program Integrity Manual (PIM) specifies procedures Medicare contractors must use to: Establish and maintain Medicare enrollment Chapter 15 dedicated to Provider Supplier enrollment Reference: Guidance/Guidance/Manuals/downloads/pim83c15.pdf 59

60 QUESTIONS? 60