855B Enrollment & Policy OverviewJoanne M. Lucas, J.D., Business Function Lead CMS

Andrea King, Education SpecialistNovitas

September 2017

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

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

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

Getting Started – The CMS-855B Application

You can find the paper application at the following link:

https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/downloads/cms855b.pdf

5

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

6

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

Section 1A – Basic Information – Reason for Application

BE SURE TO INCLUDE YOUR NPI AND MEDICARE IDENTIFICATION NUMBER, IF ISSUED, ON THE APPLICATION!

7

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

Section 2A - Identifying Information – Type of Supplier

9

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.

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

Section 2B2 – State License Information

11

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

Section 2C - Hospitals Only

13

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.

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

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

15

Section 2G – Termination of Physician Assistants (Only)

16

Section 2H –Advanced Diagnostic Imaging (ADI) Suppliers

17

Section 3 – Final Adverse Legal Actions/Convictions

18

Section 3 – Final Adverse Legal Actions/Convictions

19

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

20

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

21

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

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

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

Section 4D – Rendering Services in Patients’ Homes

25

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

Section 4F- Vehicle Information

If more than two vehicles are used, copy this section and complete it for each additional vehicle.

27

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

28

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

29

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 providerMortgage 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

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

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

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

Section 5A – Organization Identification Information

34

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

35

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

36

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

37

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

Officers and Directors Managing employees Individuals with

Partnership Interest Authorized Officials Delegated Officials

38

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

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

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

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

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

Certification Statement (Section 15 and 16)

Faxed, Photocopies, or stamped signatures are not considered original!

44

Section 15 – Certification Statements –Authorized Officials

45

Section 16 – Certification Statements –Delegated Officials

46

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

Attachment 1 – Ambulance Service Suppliers – Section A Geographic Area

48

Attachment 1 – Section B State License Information

49

Attachment 1 – Section C Paramedic Intercept Services Information

50

Attachment 1 – Section D Vehicle Information

51

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

52

Attachment 2 – Section B CPT-4 and HCPCs Codes

53

Attachment 2 – Section C – Interpreting Physician Information

54

Attachment 2 – Section D, Personnel Who Perform Tests

55

Attachment 2 – Section E, Supervising Physician

56

Attachment 2 – Section E – Other Physician Sites

57

Attachment 2 – Section E – Attestation for Supervising Physicians

58

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: http://www.cms.gov/Regulations-and-

Guidance/Guidance/Manuals/downloads/pim83c15.pdf

59

QUESTIONS?

60