How to Complete the Medicare CMS-855I Enrollment Application
CMS 855S Enrollment and Policy Overview...CMS 855S Enrollment and Policy Overview Michael Cimmino,...
Transcript of CMS 855S Enrollment and Policy Overview...CMS 855S Enrollment and Policy Overview Michael Cimmino,...
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CMS 855S Enrollment and Policy OverviewMichael Cimmino, Technical Advisor, CMS
Michael J. Holoman, Senior Provider Education Representative, NSC
September 7, 2017
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• Learn how to initially enroll, revalidate, and submit changes of information for suppliers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)
• Cover all aspects of completing the CMS-855S with a walkthrough of both the paper and PECOS versions of the form
• Learn how to avoid common mistakes when submitting the CMS-855S
Session Overview
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• The CMS form which is used for the enrollment of DMEPOS suppliers
• The National Supplier Clearinghouse (NSC) is the enrollment contractor responsible for processing all DMEPOS supplier applications
What is the 855S?
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Getting Started-The 855S Application
• You can find the 855S at the following URL:
https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/cms855s.pdf
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• Full version can be found at 42 CFR 424.57
• 2: Changes of Information• 5 & 6: Warranty Agreements• 9: Telephone requirements• 11 & 12: Beneficiary Contact• 16: Distributing Standards• 22: Accreditation• 26: Surety Bonds• 29: Practice location• 30: Hours of Business
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DMEPOS Supplier Standards
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• Suppliers enrolling for the first time• Currently enrolled suppliers reporting changes• Suppliers enrolling a new location• Suppliers needing to revalidate• Reactivation and voluntary termination
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Who should complete the 855S?
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• Suppliers must obtain an NPI and furnish it on the application prior to enrolling
• LBN and TIN must match NPPES• Suppliers can apply for an NPI using the following
link:• https://nppes.cms.hhs.gov/#/
Obtaining an NPI
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855S Instructions
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Helpful 855S Information
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Section 1A & B - Business Location/Identification
• Business Location• Location
changes must be reported to CMS via the 855S within 30 days
• Business Identification
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Section 1C - Reason for Submission
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Section 1D - What Information is Changing
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Section 2A - Business Location Information
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Section 2B - Hours of Operation
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• Min of 30 hours per week
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Section 2C & D - Business Structure
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Section 2 E - States Where Items Provided
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Section 3A - Type of Supplier
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Section 3B & C - Accreditation Information
• Be sure to report an accreditation that includes all supplies you will be providing, this will impact claims’ payment
• Accreditation is required18
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Section 3D - Products and Services• You must supply the
appropriate licensure and/or certification as failure to do so may lead to revocation or denial of your billing privileges
• Accredited products and services only
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Section 4A - Address Information
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Section 4B - Correspondence Address
• This is used to contact the provider
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Section 4C - Revalidation Mailing Address
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• Your request/reminder to revalidate will be sent to this address
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Section 4D - Special Payment Address
• New enrollees must submit an EFT Authorization Agreement (CMS-588)
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Section 4E - Medical Records Storage
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• Where/how are you storing beneficiary medical records
• PO Boxes and drop boxes are not acceptable
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Section 5 - Comprehensive Liability Insurance
• All suppliers must have comprehensive liability insurance in the amount of at least $300,000 for each incident
• Certificate liability is required to be submitted (NSC must be listed as certificate holder)
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Section 5 - Comprehensive Liability Insurance (cont.)
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Section 6A & B - Surety Bond Information
• All suppliers required to obtain a surety bond
• This applies to any persons enrolling as a DMEPOS supplier, regardless of other existing Medicare-enrolled provider types (i.e., Physician, etc.)
• Surety is required to be submitted to the NSC
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Section 6A & B - Surety Bond Information (cont.)
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Section 7 - Final Adverse Legal Actions
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• This section is for reporting organizations; individuals will be reported in section 9
• All organizations with 5% or more direct or indirect ownership interest, any partnership interest, and/or managing control must be reported
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Section 8 - Ownership Interest/Managing Control (Orgs)
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Section 8A - Ownership Interest/Managing Control (Orgs)
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Section 8B - Ownership Interest/Managing Control (Orgs)
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Section 9 - Ownership Interest/Managing Control (Inds)
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• This section is for reporting individuals; organizations are reported in section 8
• All individuals with 5% or more direct or indirect ownership interest, any partnership interest, and/or managing control must be reported
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Section 9A - Ownership Interest/Managing Control (Inds)
• All individuals are required to undergo fingerprint-based criminal background checks
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Section 9B - Ownership Interest/Managing Control (Inds)
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• If you contract with an entity or individual to prepare and submit your claims their information should be supplied here
Section 10 - Billing Agency Information
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Section 11 - Contact Person Information
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• This is the person who will be contacted for questions regarding only this application
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Section 12 - Supporting Documents
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• All applicable or mandatory documents must be included in order to avoid delays in processing your application
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Section 13 - Penalties for Falsifying Information
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Section 14 - Assignment of Delegated Officials
• An individual who is delegated the authority to report changes and updates to the supplier’s enrollment record by an authorized official
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Section 15A - Authorized Official Certification Statement and Signature
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Section 15B - Authorized Official Signature(s)
• All AOs must be reported in section 9 and at least one must sign in section 15 here
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Privacy Act Statement
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• Your information will be entered into PECOS
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Medicare Enrollment Fees DMEPOS Suppliers CY 2017 - $560 Non-refundable
Credit Card, Debit Card, Electronic Check New locations, Additional Locations, Revalidations
&Reactivations, Applications are not processed until funds are cleared
https://pecos.cms.hhs.gov/pecos/feePaymentWelcome.do
NSC Reminders
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Mailing AddressPalmetto GBA
National Supplier ClearinghouseP.O. Box 100142
Columbia, SC 29202-3142Overnight Mailing Address
Palmetto GBANational Supplier Clearinghouse AG-490
2300 Springdale Dr., Bldg. 1Camden, SC 29020
Phone Number (866) 238-9652, M-F 9:00 AM - 5:00 PM, ET
http://www.PalmettoGBA.com/NSC
E-mail: [email protected]
Resources
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Online Application Status Tool Search by PTAN, NPI, TIN, DCN www.palmettogba.com/nsc
Interactive Voice Response (IVR) Unit General information regarding the enrollment process Information on the appeals process Status of applications Instructions on how to obtain a CMS 855S Contact information for the NSC, DME MAC and CMSThe IVR is available 24 hours a day, seven days a week (except for routine system maintenance) and can be accessed by calling the NSC Customer Service Line at (866) 238-9652
Resources
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NSC Web Submission Form
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• 855S not required
• Appeals• Licenses• Surety bonds• Certificates of
insurance
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Questions
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