Medicare Provider Enrollment Services

We specialize in all aspects of Medicare Enrollment and will work quickly and correctly to complete the enrollment process with your local Medicare administrator.  We offer our Medicare credentialing services nationwide and have completed over 15000 Medicare applications in the past 15 years.  We can also provide assistance if your Medicare application has been delayed or returned due to errors on your end or on the part of the enrollment analyst at Medicare. Medicare issues can cost you thousands of dollars in lost revenue if done incorrectly. 

  • Nationwide Medicare Experts
  • Certified Coders and Credentialing Professionals
  • Successfully Enrolled over 15000 Providers since 2008
  • Familiar with all aspects of Medicare Enrollment process
  • Credentialing Specialists familiar with all CMACs
  • 100% of Staff is based here in the US

 

Medicare Credentialing Scenarios

Many providers think that because you’re participating in one state or under a different practice, that those credentials follow you to the next organization. No matter how simple the move or if you’re only working out of a new office next door to your current one, there is always some type of Medicare application that is needed before you can start seeing patients.

Here are some common scenarios where a Medicare enrollment specialist is helpful:

  1. Did you open a new practice location?  Have you notified Medicare so you can bill for the services?
  2. Did a physician leave your practice in the past?  Are you aware that Medicare must be notified of this change?
  3. Have you changed billing companies?  This new agency must be on file with Medicare.
  4. Did you have a change of ownership?  This must also be provided to Medicare.
  5. Are your claims being denied and you are not sure why?
  6. Are you opening an office and not sure where to start?
  7. Would you like to bill for DME but don’t have a supplier number
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medicare application types

You may either use the PECOS external link to enroll online or mail a paper application form.  We strongly recommend you completing your application on PECOS.  The PECOS system manages, tracks, and validates enrollment data collected in both paper form and electronically via the internet. PECOS applications are processed much faster than paper applications and have less risk of error.  To find out more about PECOS, please refer to the PECOS FAQs external link. 
 
The direct link for each Medicare provider/supplier enrollment application is shown below:
  1. Institutional/Facilities: CMS-855A external pdf file
  2. Clinics/group practices and certain other suppliers: CMS-855B external pdf file
  3. Physicians and non-physician practitioners (including clinical psychologists, nurse practitioners, therapists, physician assistants and most other provider types): CMS-855I external pdf file
  4. Reassignment of benefits(this is needed to link a provider to a credentialed Medicare group): CMS-855R external pdf file
  5. Ordering, certifying and prescribing providers: CMS-855O external pdf file
  6. Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers: CMS-855S 
  7. PECOS
  8. We have a very helpful tutorial on using PECOS which can be found here.
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Retroactive Billing for Medicare

The short answer is Yes, but there are some specifics that you need to be aware of.  Retroactively billing Medicare is critical for most organizations as providers often start without having a Medicare number.  Your retroactive period begins once an application has been submitted but the application submitted must be accepted.

If the application is rejected due to incomplete data or because a provider doesn’t meet Medicare standards, you will lose the retroactive billing date and must start the application process over.  This is why it’s so critical to stay on top of the Medicare enrollment process and ensure your application is processed without any issues.  If mailing anything to Medicare, be sure to send certified and keep a copy of the tracking certificate.   If submitting through PECOS, make sure to get a tracking id and regularly check on the status.

Source: https://physicianpracticespecialists.com/credentialing/can-you-retroactively-bill-medicare-after-credentialing-is-complete/

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/Downloads/2019_National_Provider_Enrollment_Conference_Medicare_Effective_Dates.pdf

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Medicare Revalidation

  • How often do you need to revalidate Medicare?
    • As a participating Medicare provider, you are required to revalidate (renew) your enrollment record periodically to maintain Medicare billing privileges. This ensures compliance with the CMS guidelines.  As a rule, providers and suppliers are required to revalidate every five years.  However, DMEPOS (Part S) suppliers revalidate every three years. CMS also reserves the right to request off-cycle revalidations.
  • How do I revalidate Medicare? 
    • To complete the revalidation process, you can do it one of three ways.  The first method is through PECOS which is our preferred method.  When completing your PECOS enrollment revalidation, you will be required to upload all of your supporting documentation.  PECOS revalidation apps are processed much faster and have less room for error than the paper applications. The second way is to complete the required paper application and send in all of your supporting documents.  The final method is to contact us so we can help ensure your revalidation application is submitted accurately and in a timely manner.
  • What are the risks if I fail to revalidate?
    • Failure to revalidate your enrollment record will result in your Medicare provider number being deactivated.  This will obviously cause your claims to be denied and prevent your referring providers from sending you Medicare patients.
  • Is my enrollment record due for revalidation?
    • The easiest way to find out if you are due for revalidation is to use the revalidation lookup tool provided by CMS.  Due to COVID, some of the past due revalidations were given an extended grace period but if it says you are due, then you need to get working on it ASAP.  Here is a link to the tool: CMS Revalidation Lookup Tool
Revalidate My Medicare Record
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Completing Pecos Application

We highly recommend utilizing PECOS for all Medicare applications.  This is primarily due to the timeline associated with PECOS applications vs those completed on paper.  If you read the Medicare processing guidelines, you’ll find that the Medicare Administrative Contractors (MACs) have twice as long to process paper applications vs any application completed using PECOS.  This is according to the rules laid out my CMS and is something you can reference if the application processing timeline extends beyond 90 days. 

We also prefer PECOS due to the error checking and address validation feature.  It audits your enrollment application to verify that you’ve completed all of the fields and further validates that you’re using the correct Group NPI. 

For more information on PECOS or to complete a Medicare application using their system, visit their website at: https://pecos.cms.hhs.gov/pecos/login.do

We have provided a very helpful article on completing your PECOS Medicare application here.

 

pecos
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Medicare enrollment Services we provide

  • PECOS profile setup and application submission.  You can view your PECOS profile here: https://pecos.cms.hhs.gov/pecos/login.do
  • Enrollment for your new entity, any locations and all providers within your organization
  • Complete the enrollment process for your new entity and ensure your individual Medicare number is properly linked.
  • Complete all necessary applications and forms depending on the type of facility or situation.
  • Obtain your Group NPI if necessary and ensure the crosswalk between Medicare and NPPES is set up correctly.
  • Complete the Electronic Funds Transfer and Electronic Data Interchange process (EFT & EDI)
  • We do it all and let you focus on the 900 other things that you need to do.
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Provider Types We Work With

We complete the medicare enrollment process for the following provider types:

  • Physicians
  • Hospitals
  • Imaging Facilities
  • DMEPOS Groups
  • Nurse Practitioners & Physician Assistants
  • Behavioral Health Specialists
  • Licensed Clinical Social Workers
  • Chiropractors
  • Any other eligible Medicare Part A/B or S provider
Provider Enrollment

Our medicare provider enrollment services are offered nationwide to individuals and groups

DME Enrollment

We handle initial and revalidation applications for new and established DMEPOS suppliers

Facility ENROLLMENT

We provide initial and revalidation medicare enrollment services to hospitals of all types and sizes

Lab Enrollment

Medicare enrollment and facility credentialing offered to labs in all 50 states

 

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CMS Fee Schedule Tool

Do you know what each office visit or procedure is paying you? 

How much more does a 99203 pay than a 99213? 

This valuable fee schedule tool provided by CMS will tell you how much each code is paying currently and how much they have paid historically.  Many of your insurance contracts are based on prior year Medicare fee schedules so it is vital that you are equipped with this knowledge.  In this tutorial, we show you exactly how to utilize this tool to analyze your top codes.

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Schedule Free Consultation

Email Us For Urgent Requests

If you’ve requested a resource, we’ll email you the requested document(s).  We also wanted to provide you with an opportunity to schedule a free consultation.  Cut down on the emailing and phone tag by scheduling on our calendar below.

**If you’re applying for a position or trying to sell us something, we politely ask you to refrain from using this tool. We will contact you to schedule a meeting if we’re interested in discussing your services or our position.**


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