B7VFlqRTss9WXxIL5Ydri0WcK0XxnB5: Medicare

Medicare Announces Charging for Enrollment

Medicare will start charging fees for some enrollment applications

Wow, I'm not sure why this surprised me so much but when I saw this email I was surprised. Medicare is going to start charging providers who submit enrollment applications? Well it's not all providers, but still it is going to affect many. But the CMS (Centers for Medicare and Medicaid Services) announced that effective Friday, March 25, 2011 Medicare Administrative Contractors will begin collecting application fees for certain provider/supplier enrollment applications. This is for both paper and online, or PECOS, applications.

How much will this application fee be? That is the first question I had. But the answer is not clear. It appears that they are charging $500 for new enrollments for 2010 but since it wasn't effective until March of 2011 I was left a little perplexed. Anyway, it looks like the fee for 2011 is $512 for new enrollments and $200 for revalidations and/or adding practice locations.

Also, the fee is not applicable to all providers. The fees do not apply to physicians, non-physician practitioners, physician organizations, and non-physician organizations. It is only applicable for institutional providers of medical or other items or services or suppliers. It is applicable for the CMS-855A, CMS-855B (not including physician and non-physician practitioner organizations), and CMS-855S applications.

Personally, I think this is going to cause some major confusion. As if it wasn't hard enough for providers to just figure out what forms need to be submitted, now they need to determine if they need to pay. Also, some of the MAC's (Medicare Administrative Contractors) are already difficult to deal with. (Just for the record, some are very pleasant and helpful.) Now they have another way that they can return apps stating that the fee was not included, even if no fee was needed. As we all know, Medicare being a government agency is full of red tape. If the provider makes a mistake they have to fix it, but if the MAC makes a mistake, the provider still has to fix it.

And I find it very ironic that Medicare is now requiring all providers to accept payments through EFT (electronic funds transfer) but they are requiring payment for these apps by paper check. They haven't developed a mechanism yet for receiving payment electronically. Of course they will have exceptions based on hardship but those will be determined on a case by case basis at the discretion of the MAC. I think consistency will be an issue there. There is a published document but it was a little difficult to wade through all 110 pages.

I'm usually a "glass is half full" person and as I read back through this I feel I'm being quite negative. However, after doing thousands of Medicare applications over the past several years, I have seen many problems in the application process. To me, this addition of a fee is just going to complicate things even more. We'll be watching to see how it plays out!

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Part B Benefits of Medicare

Within the total benefits of the Medicare system, Part B covers some of the most common medical expenses. Medicare Part B is a public insurance program that helps qualified citizens pay for medical expenses like going to be doctor and covering some preventative procedures. This type of coverage is useful for all different types of outpatient doctor's bills including home health services and other medically-necessary services.

Part B is different from other parts of the Medicare plan because you do pay a monthly premium for this type of coverage. Part B coverage payments are typically standard no matter what your income is. There are adjustments that can be made to a person's payment amount if their modified adjusted gross income from two years prior was above a certain amount. This coverage is generally automatically received when a person begins to receive Social Security, but if a person enrolls in Part B coverage later than their enrollment in Social Security a penalty fee may be included in their insurance payment.

These benefits are automatically extended to a person on the day they begin to receive either Social Security payments or Railroad Retirement Board payments. This typically occurs the day that a person turns 65 unless their birthday is on the first day of the month. There are also conditions that allow a person to receive Part B benefits if they are under the age of 65. Typically, this type of coverage is extended to people who are disabled or diagnosed with Lou Gehrig's disease.

For more information regarding Part B coverage from Medicare, please contact the California Medicare insurance agents at Catherine Michaels Insurance Services.

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CMS - Medicare PECOS Ruling May Affect Payments by Medicare

CMS originally had a deadline of July 6, 2010 for all ordering and referring providers to be enrolled in the PECOS system, or the Provider Enrollment, Chain and Ownership System but in the June 30th news release they announced that they will not be making the changes that will automatically reject claims based on ordering or referring providers who have not yet had their PECOS applications approved. What does all of this mean?

Well it's actually good news for any providers who order services or refer patients enrolled in Medicare, and have not enrolled yet in PECOS. Basically if a provider has not enrolled in Medicare or submitted changes or updates to their Medicare Information in the past 6 years, then they probably are not enrolled in PECOS. If a provider has enrolled or submitted changes/updates in the last 6 years, then they should be already enrolled in PECOS. The Medicare contractor would have automatically input the application into the PECOS system, even if they submitted a paper application.

So if the provider has been enrolled in Medicare longer than 6 years and has not submitted any updates or changes, then they still need to enroll in PECOS. The PECOS system can be accessed at the Medicare website. They should use their NPI login username and password to access the system.

CMS has been encouraging providers to use the PECOS system to enroll in Medicare or submit any updates or changes to their Medicare information for quite a while. Now they are mandating the use of PECOS by denying any claims for services that were ordered or referred by a Medicare provider who is not enrolled in the PECOS system. This makes things tough because the provider submitting the claim cannot control if the ordering or referring provider has enrolled in PECOS. This may be why they announced that they would not make the changes that would result in the denial of claims that were ordered or referred by providers not enrolled in PECOS.

At some point, this mandate probably will be implemented so it really is in a provider's best interest to make sure they are compliant. If you do not know if you or your provider is enrolled in PECOS then you should check. There is a national list available. It has the names and NPI numbers of all providers in the US who are enrolled in the PECOS system. You can check that list to see if you or your provider is enrolled. You can also call the local Medicare carrier provider enrollment line and ask if you or your provider is already enrolled.

If you or your provider is not enrolled you will either need to enroll by completing the application online through the PECOS website, or by submitting a paper enrollment application re-validating the information, even if nothing has changed. I would suggest that you don't wait until claims do start to get denied. If you are a billing service you should check the list for all of the providers you bill for and advise them if they are or are not all set. If they are not, you should advise them what needs to be done.

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