Medicare Enrollment - question and answer part 2

Q: As an established provider with Medicare who receives paper checks, does an electronic funds transfer (EFT) agreement need to be included when I submit a change to my provider enrollment file?

A: Yes, unless you are reassigning all of your Medicare benefits to your employer or a clinic/group practice.

First Coast Service Options Inc. (First Coast) requires the Electronic Funds Transfer (EFT) authorization agreement (CMS-588) form if you are submitting an initial provider enrollment application or a change to an existing Medicare provider file that has not previously been set up for EFT.

When submitting the EFT authorization agreement, be sure to use the CMS-588 (09/13) version external pdf file of the form. The form must be complete, accurate, and include the original signature of the authorized/delegated official, as well as the signature date. Remember to include a confirmation of the account information on bank letterhead and/or a voided check. With the EFT authorization, Medicare can send payments directly to your financial institution whether claims are filed electronically or on paper.

Note: Please check with your bank for the proper number to report as the routing number on your EFT form. First Coast has determined that some banks may not use the routing number located at the bottom of your pre-printed check or deposit ticket for direct deposits but may use the automated clearing house (ACH) number located elsewhere on the check or deposit ticket.
An organization or facility does not need to submit an EFT for each of its members, only for the legal entity.



Q: What will First Coast Service Options Inc. (First Coast) provider enrollment accept as a "good standing letter"?
A: First Coast will accept a current letter or license from the state medical licensing board to validate that the provider is in good standing.


Q: If I have previously enrolled with Medicare and have an active provider transaction access number (PTAN) but I am unsure what it is, how would I obtain my PTAN from First Coast Service Options Inc. (First Coast)?
A: Send a written request on company letterhead to:
Provider Enrollment
P.O. Box 44021
Jacksonville, FL 32231-4021

Q: A group has three practice locations and two of those practice locations are changing addresses and will have their own Type 2 Organization National Provider Identifier (NPI). What needs to be done to update the enrollment information, and how should claims be submitted that were generated with the old Type 2 Organization NPI?
A. For enrollment information -- the group would need to provide the new addresses and NPIs for the locations. This can be done via the Internet using the Provider Enrollment, Chain, and Ownership System (PECOS) external link or via the appropriate paper CMS-855 form external link.
For submission of claims -- if the Provider Transaction Access Number (PTAN) is the same for all three locations, then use the appropriate NPI for the location where the services were rendered. Since the PTAN is the same for all three locations, all three of the NPIs, the original one and the two new ones, would be linked to this PTAN.

If the PTAN is different for all three locations, then you must use the current NPI that has been associated with that PTAN. For the new addresses, you would be required to use the new NPIs on all claims once the information has been updated.

Q: I just received a revalidation request letter from First Coast Service Options Inc. (First Coast). Where can I find more information regarding the provider revalidation process and how to properly respond to a revalidation request?
A: First Coast Service Options (First Coast) will be mailing revalidation request letters to affected providers. You may receive a revalidation request -- enclosed within a yellow envelope -- at any time during that time period.

A revalidation is a complete and thorough re-verification of the information contained in your Medicare enrollment record to ensure it is still accurate and compliant with Medicare regulations.

Q: When is the application fee required for processing provider enrollment applications?
A: With the exception of physicians, non-physician practitioners, physician group practices and non-physician practices, providers and suppliers that are (1) initially enrolling in Medicare, (2) adding a practice location, or (3) revalidating their enrollment information, must submit with their application:
• An application fee in an amount prescribed by CMS, and/or
• A request for a hardship exception to the application fee

Note: The fee for January 1, 2015, through December 31, 2015, is $553.00
This requirement applies to applications that First Coast Service Options (First Coast) receives on or after March 25, 2011. Note that a physician, non-physician practitioner, physician group, or non-physician practitioner group that is enrolling as a DMEPOS supplier via the CMS-855S application must pay the required application fee.

Note: Do not mail application fee payments. Payments cannot be accepted by mail or phone.
For providers that continue to use the CMS-855 paper enrollment applications, access https://pecos.cms.hhs.gov/pecos/feePaymentWelcome.do external link to pay the application fee. For those who submit applications online via Internet-based Provider Enrollment, Chain, and Ownership System (PECOS), as you proceed through the application process, if a fee is required, you will be prompted to submit your payment.

The application fee is non-refundable, except if it was submitted with one of the following:
• A hardship exception request that is subsequently approved
• An application that was rejected prior to the Medicare contractor’s initiation of the screening process
• An application that is subsequently denied as a result of the imposition of a temporary moratorium as described in 42 CFR 424.570
Even though the Centers for Medicare & Medicaid Services (CMS) will send on a regular basis to First Coast a listing of providers and suppliers that have paid the application fee, it is still encouraged that provider/suppliers send with their application a copy of the receipt that is received after making the payment.

Q: If a provider/supplier establishes a new practice, opens a new facility, or closes/changes the address of an existing practice/facility, how long does the provider/supplier have to inform Medicare of the “reportable event”? How should the change be reported?
A: Any change in practice or facility location (e.g., establish new location, move existing location, close existing location) address must be reported to the provider/supplier’s Medicare administrative contractor (MAC) no later than 30 days after the “reportable event” occurred.
Providers and suppliers should utilize the Internet-based Provider Enrollment, Chain, and Ownership System (PECOS) external link to update their Medicare enrollment record. Registered users may use the system for initial enrollment as well as to change, reactivate, or voluntarily terminate an existing enrollment record.

Q: What is the difference between the effective date and retrospective billing date?
A: The effective date is the later of the following two dates:
• The filing date of an enrollment application that was subsequently approved, or
• The date the provider first began furnishing services at a new practice location.
The provider may bill retrospectively for services when:
• The supplier has met all program requirements, including state licensure requirements, and
• The services were provided at the enrolled practice location for up to
1. 30 days prior to their effective date if circumstances precluded enrollment in advance of providing services to Medicare beneficiaries, or
2. 90 days prior to their effective date if a presidentially-declared disaster precluded enrollment in advance of providing services to Medicare beneficiaries.

Example:
Suppose that a non-Medicare enrolled physician began furnishing services to beneficiaries at her office March 1. She submitted the CMS-855I initial enrollment application May 1, and the application was approved June 1. The physician’s effective date of enrollment would be May 1, which is the later of: (1) the date of filing, and (2) the date she began furnishing services. The retrospective billing date is April 1 (or 30 days prior to the effective date of enrollment).

Q: What applications do we complete to add a provider to our group?
A: The CMS-855I may be used to add a provider who is initially enrolling or making changes to that provider’s personal information. The CMS-855R is used to reassign the individual’s benefits to the group. This information can also be captured in Internet-based Provider Enrollment, Chain and Ownership System (PECOS).


Q: How often do I change my password for PECOS Identity & Access (I&A)?
A: PECOS Identity & Access (I&A) requires that a password is changed every 60 days. You will not be able to access PECOS I&A or Internet-based PECOS if your password expires.


Q: I created an application in Internet-based PECOS but never submitted it. That application is now no longer needed. What should I do?
A: You may delete the application if it has not been submitted. You can do this by logging in, then select My Enrollments, and click on View Enrollments beside the appropriate provider or organization. After selecting the correct provider or organization that the application was created for, click on More Options beside the pending application. This will provide an option for deleting the application.

Q: I have moved and need to enroll in a different state. How do I do this on Internet-based PECOS?
A: Start by terminating the previous enrollment for the state in which you are no longer residing or working. For the new state, log into your current Internet-based PECOS account, select My Enrollments, and then select New Application. The applicant questionnaire will determine that you are enrolling in a new state