Jurisdiction 6: Revalidation of Provider Enrollment ... · – CMS 855A – CMS 588 – EFT . 38 National Government Services, Inc. ... –FQHC • HRSA Notice of Grant Award if that

Jurisdiction 6: Revalidation of Provider Enrollment Information

1509_1114

2 National Government Services, Inc.

Today’s Presenters

• Laura Brown – Provider Outreach and Education Consultant


Today’s PowerPoint Presentation

The NGSMedicare.com Home Page: • I am a…

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Disclaimer

• National Government Services, Inc. has produced this material as an informational reference for providers furnishing services in our contract jurisdiction. National Government Services employees, agents, and staff make no representation, warranty, or guarantee that this compilation of Medicare information is error-free and will bear no responsibility or liability for the results or consequences of the use of this material. Although every reasonable effort has been made to assure the accuracy of the information within these pages at the time of publication, the Medicare Program is constantly changing, and it is the responsibility of each provider to remain abreast of the Medicare Program requirements. Any regulations, policies and/or guidelines cited in this publication are subject to change without further notice. Current Medicare regulations can be found on the Centers for Medicare & Medicaid Services (CMS) website at http://www.cms.gov.

http://www.cms.gov/


No Recording

• Attendees/providers are never permitted to record (tape record or any other method) our educational events – This applies to our webinars, teleconferences, live

events, and any other type of National Government Services educational event


Acronyms

• Please access the Provider Resources / Acronyms page on the NGSMedicare.com website to view any acronym used within this presentation.


Objectives

• Provide an overview of the requirements for providers to revalidate their enrollment information

• Explain the required supporting documentation to submit with the revalidation


Agenda

Revalidation Overview When to Revalidate Non-response to Revalidation Requests Non-response to Additional Information Requests Internet-Based PECOS/CMS 855 Paper Applications Enrollment Information Supporting Documents Application Fee Contact and Mailing Information Application Status Inquiry Tool


Revalidation Overview

• Section 6401(a) of the Affordable Care Act established a requirement for all enrolled providers and suppliers to revalidate their enrollment information under new enrollment screening criteria.

• Approximately 1.5 Million providers and suppliers must be revalidated by 2015



• Affects all providers and suppliers enrolled prior to 3/25/2011

• Enrolled providers and suppliers revalidate enrollment information every five years

• Providers and suppliers have 60 days to submit the enrollment applications once they receive the revalidation Notice



• DO NOT submit a revalidation application until you receive your revalidation notice from National Government Services (NGS). You will receive a notice between now and March 2015.

• Attach a copy of the revalidation notice to the front of the application


When to Revalidate

• National Government Services will mail the revalidation notices in an optic yellow envelope.


When to Revalidate

• Sample Notice


When to Revalidate

• A list of providers who received the revalidation notice is posted on both the NGS and CMS websites. – http://www.NGSMedicare.com

– http://www.cms.gov


http://www.cms.gov/


When to Revalidate

http://www.NGSMedicare.com • Part A

– Task - Revalidate My Enrollment • Related Content – Consolidated Revalidation Lists for J6 and JK



When to Revalidate

http://www.NGSMedicare.com • Part B

– Obtain Revalidation Instructions Task • Step 1 - Consolidated Revalidation Lists for J6 and JK



When to Revalidate

• http://www.cms.gov – Medicare – Medicare Provider-Supplier

Enrollment • Revalidation • Downloads

– CMS Official List

http://www.cms.gov/


When to Revalidate

https://pecos.cms.hhs.gov • PECOS

– My Enrollments – View Enrollments – Existing Enrollments

• Revalidation Notice Sent

https://pecos.cms.hhs.gov/


When to Revalidate

https://pecos.cms.hhs.gov • PECOS - Entities

– My Enrollments – Reassignment Report

• Revalidation Notice Sent date



Non-response to revalidation requests

• Failure to revalidate your enrollment information in a timely manner will result in the providers Medicare claims payment being placed on hold or billing privileges being deactivated.

• Upon receipt of the revalidation request from your MAC, providers and suppliers have 60 days from the date of the notice to submit complete revalidation information and required supporting documents


Non-response to additional information requests

• Failure to respond in a timely manner to additional information request will result in the providers Medicare claims payment being placed on hold or billing privileges being deactivated.

• Additional information request could be mailed or emailed – Please remember to view both your inbox and junk mail folder


Internet-Based PECOS

• Enrollment Mega Tab – Learn More about PECOS

• Advantages to submitting via PECOS

– Faster than paper – Check and update easily – Less time spent

– Log in to PECOS Web



https://pecos.cms.hhs.gov • PECOS

– My Enrollments – View Enrollments – Existing Enrollments

• Revalidation




https://pecos.cms.hhs.gov • Topics

– Personal Information – Practioner Specialty – Physical Location and special

payment address – Contact Person – Electronic Funds Transfer




https://pecos.cms.hhs.gov • E-Signature

– Yes submit electronic – No I choose to submit a hard

copy




https://pecos.cms.hhs.gov • Submission Page

– Medicare Contractor – Reason for Submission – Required and support

documents



Internet-Based PECOS/CMS 855 Paper Applications

https://pecos.cms.hhs.gov • Submission Page

– Required and support documents

• Upload and Remove Documents

• View attached documents – Complete Submission



Internet-Based PECOS/CMS 855 Paper Applications

https://pecos.cms.hhs.gov • Submission Confirmation

– Important Message • Confirms Application

Submission • Required/supporting

documents not upload must be mailed, including signature page (if applicable)

• Required/supporting documents missing can delay or stop the process



CMS 855 Paper Applications

• Paper Applications – Current CMS-855 (09/11) – Complete online then print

and mail



http://www.NGSMedicare.com • Part A-Paper Applications

– CMS 855A – CMS 588 – EFT




http://www.NGSMedicare.com • Part B-Paper Applications

– CMS 855B - Business – CMS 855I – Individual – CMS 588 – EFT

NOTE: CMS 855R is not required during revalidation




CMS 855A • PAPER

– Sections – All applicable sections except 2F, 2G and 2H – Section 4 – List each practice location – Section 4 – List each Medicare Number and NPI you would like

link to that number – Section 6 – Complete for each owner, board of director,

authorized official and delegated official – Section 6 - One managing employee is required – Section 15 - Signed and dated by an Authorized Official



CMS 855B • PAPER

– Sections – All applicable Sections – Section 2B – Legal Business Name as indicate on IRS document – Section 3 – Adverse Legal Action – Section 4 – List each practice location, this includes every

office, clinic, hospital, assisted living community, skilled nursing facility or any other health facility you render services.

– Section 6 – Complete for each owner, board of director, authorized official and delegated official

– Section 6 - One managing employee is required – Section 15 - Signed by Authorized Official



CMS 855I (Individual) • PAPER

– Sections – All applicable Sections – Section 1A – Physician assistant indicate PTAN and NPI – Section 2 –Identifying Information – Section 3 – Adverse legal action – Section 4A – Incorporated Sole Owner NPI – Section 4 – List each practice location, this includes every

office, clinic, hospital, assisted living community, skilled nursing facility or any other health facility you render services.

– Section 4F –Sole proprietor billing under TIN – Section 15 – signed and dated by individual practitioner



CMS 855I (Reassignment) • PAPER

– Sections 1A, 2, 3, 4B, 13 & 15 – Section 4B – Indicate reassignments – include groups legal

name, PTAN, and NPI – Section 15 – signed and dated by individual practitioner

– NOTE: CMS 855R does NOT need to be submitted during revalidation


Enrollment Information

• Attach a copy of the revalidation notice to the revalidation request

• Verify all sections or topics are completed/updated

• Verify an authorized official signs section 15 or electronically signs PECOS for groups/entities

• Verify the individuals practitioner signs section 15 or electronically signs PECOS for individual enrollments


Enrollment Information

• Verify that all supporting documents are submitted (Refer to section 17 of the paper application if needed)

• Verify that each PTAN and NPI are identified and addressed during the revalidation process

• Paper CMS 855 applications – verify you are submitting the correct version (CMS 855 (07/11))


Supporting Documents

• Documentation Checklist – Copy of revalidation notice

– Application Fee

• Pay and submit a payment receipt or a hardship request

– License, national certifications and registrations required by Medicare or State Law for non-physicians



• Documentation Checklist – Federal, State and/or Local Business License,

certifications and/or registrations required to operate a health care facility

– Adverse Legal Action documentation • All adverse legal action documentation (e.g., notifications,

resolutions, and reinstatement letters)



• Documentation Checklist – Internal Revenue Service (IRS) Document

• Preprinted from IRS that list legal name and tax identification number (TIN)

• Legal name must match: – NPI registry – Name on CMS 855 Application and PECOS – CMS 588 Electronic Funds Transfer (EFT) Agreement – Name on Bank Account

» Bank account can not be a joint account

• NOTE: IRS Document not needed for Sole Practioners billing under SSN



• Documentation Checklist – CMS 588 (9/13 version) Electronic Funds Transfer

(EFT) Agreement • Name indicated on CMS 588 must match exactly with IRS

document or Social Security office for individuals • Full name of the financial institution’s contact person • Submit a void check or letter from bank

– Letter must be signed by bank official verifying account and tracking number

– Must only list the legal business name, not the Doing Business As (DBA) name on check or letter

– Bank account name must match Legal name, individual or group

• NOTE: EFT not needed for individual providers reassigning all benefits to groups



• Documentation Checklist – FQHC

• HRSA Notice of Grant Award if that is a qualifying document for FQHC status

– – Non-profit

• IRS Determination Letter, if provider is registered with the IRS as non-profit

– Government entities and tribal organizations

• An attestation



• Documentation Checklist – Ambulance

• Registration of all vehicles • Paramedic intercept contract • Air Ambulance - Federal Aviation Administration (FAA) 135

Certificate – IDTF

• Must meet the 17 CMS performance standards – 42 C.F.R. section 410.33(g)

• Comprehensive liability insurance policy • Personnel – license or certifications of supervising physician,

interpreting physicians, and all technicians


Application Fee

• Application Fee: – If you are one of the provider types listed on the next

slide, you must pay the application fee via the https://pecos.cms.hhs.gov/pecos/feePaymentWelcome.do; submit a copy of your payment receipt with the application

– Refer to the Application Fee page on our website for additional information

https://pecos.cms.hhs.gov/pecos/feePaymentWelcome.do

https://pecos.cms.hhs.gov/pecos/feePaymentWelcome.do

http://www.ngsmedicare.com/ngs/portal/ngsmedicare/mandatory provider revalidations--required documentation and helpful hints/!ut/p/a1/zVFBbsIwEPxKOHBE3kBwzDGiBZWSIpVKJblUTuwkRo4dHBO1v68TCbU9oLZSD_VtZ9a7MzsoRQeUKtqJklqhFZV9neIX2OyX0WoeAMQLgLsI71frNcyCJaBnlKI0V7axFUpU2daciZwanmtlubJj-ISNgSujpawd4VHFvLyiquTtF9xqLR1SO55abd68xuhOMG48wzsqBRuktZOJ4aezMJx5TOfn_utADHMrLpviLL1KKNv2AhtacsZbUaqhygVDCckWWQEAAVlkPsVZhn2ShSGm_gzPCYTOe9J7v_Ii-NFprrfsHqaXhusrEqch_JiwW69u3AT_iezu41s_8NH-F4Y23yl2jsXxdEojF2mf36tFh_-ZqVM6NfEyLvtsbTURqtDo8IcLmromx2KLHwnM5rLbRtFo9A6zOYFn/dl5/d5/L2dBISEvZ0FBIS9nQSEh/?1dmy&urile=wcm:path:/ngsmedicarecontent/ngsmedicare/enrollment%2Band%2Bchanges/enrollment%2Btools/application%2Bfee_part%2Bb

52

National Government Services, Inc.

Application Fee

• All providers who bill Part A

• Ambulance Service Supplier

• Ambulatory Surgical Center (ASC)

• Independent Clinical Laboratory (CLIA)

• Independent Diagnostic Testing Facility (IDTF)

• Portable X-ray Supplier

• Mammography Center

• Mass Immunization/Roster Biller

• Pharmacy

• Radiation Therapy Center

• Histocompatibility Laboratory


Application Fee

http://www.NGSMedicare.com – Medicare Enrollment Application Fee Decision Tree – Pay Application Fee



Contact and Mailing Information

• NGS Provider Enrollment Contract State and Territories Contact Information Part A, HH+H and FQHC

Illinois, Minnesota and Wisconsin, FQHC and HH+H

Phone: 855-834-5596 Mailing CMS 855 Forms: National Government Services, Inc. P.O. Box 6474 Indianapolis, IN 46206-6474

Part B Illinois, Minnesota, and Wisconsin

Phone: 877-908-8476 Mailing CMS 855 Forms: National Government Services, Inc. P.O. Box 6475 Indianapolis, IN 46206-6475



• NGS Provider Enrollment Line – Please Note: Provider enrollment representative will

only be able to assist those listed as the contact person on the application, the provider themselves, and/or the authorized/delegated official for the practice.

– If the caller is not one of these persons, Provider Enrollment representatives will only be able to release general case status (i.e., received/pending/finalized) of the application



• PECOS For Assistance with Contact Contact Information

Errors encountered while accessing or entering information in PECOS

Forgotten PECOS user ids and passwords

PECOS EUS Help Desk

Phone: 866-484-8049 TTY: 866-523-4759 Email: [email protected]

mailto:[email protected]


Application Status Inquiry Tool

http://www.NGSMedicare.com • Check Enrollment Application Status



Application Status Inquiry Tool

http://www.NGSMedicare.com • Search

– Option1: Case Number – Option 2: NPI and TIN



To Ask a Question Using the Question Box


Medicare University Self-Reporting Instructions

• Log on to the National Government Services Medicare University site at http://www.MedicareUniversity.com – Topic = <Insert course name/delete arrows> – Medicare University Credits (MUCs) = # – Catalog Number = <Insert catalog number> – Course Code = <Enter course code> – For step-by-step instructions on self-reporting, visit

the “Education” mega-tab of our NGSMedicare.com website and click on “Medicare University”

http://www.medicareuniversity.com/


Thank You!