Physicians and office managers and administrators will certainly become more organized after becoming a Medicare Provider. The Medicare requirements will compel you to learn how to bill your claims correctly, keep abreast of the current Federal clim guidelines, and to always have your credentialing paperwork in tip top shape.
Additionally, Medicare allows and will mandate that all physicians participate in their Physician Quality Reporting Initiative (PQRI). Doctors will report data on specific quality measures furnished to Part B beneficiaries and paid under the Medicare Physician Fee Schedule. The program was first implemented in 2007 and by 2010, 30 individual and 6 measure groups on which EP's may report have been added to the PQRI system. Indeed by June 30, 2011 physicians must start reporting data on E-prescribe or face reimbursement losses in 2012.
In 2010, physicians earned an incentive payment of 2.0 percent of their estimated total allowed charges for Medicare covered professional Part B services.
These incentives are based on provisions in the Medicare Improvement for Patients and Providers Act of 2008 (MIPPA). One of the goals of MIPPA is to provide such incentives based on participation in the investigation and implementation of electronic health records. It is MIPPA's intention to have all providers and group practices participate in Electronic Health Records by 2012.
Providers will be able to report their use of e-prescribe through certified MIPPA registries or through e-prescribe vendors who have been successfully recognized as qualified to provide these services.
A fact sheet providing more information about both the e-prescribe program and PQRI provisions can be found at : www.cms.hhs.gov/apps/media/factsheets.asp
Providers can enroll in the Medicare program either by mail or via an online application.
Physicians who are enrolling in Medicare for the first time will need to complete CMS form 855I and 855R (in order to reassign their benefits) Do not attempt to complete this paperwork before reading the specific guidelines for each section. The physician/ non-physician practitioner should refer to:
Tips to Facilitate the Medicare Enrollment Process for Physicians and Non-Physician Practitioners as well as CMS 855I Section Specific Tips prior to completing the applications.
If your application is not filled out correctly, chances are that it will come back to you hole-punched and voided and you will have to download the forms and start the process from page 1.
Form 855I requires personal and professional information regarding the applicant along with all pertinent practice details. In order to make life easier, you will refer to your physicians information folder or scanned documents mentioned in a earlier blog. You will not be able to submit the 855I without having an NPI number.
To create a web user account and apply for an NPI at NPPS go to:
https://nppes.cms.hhs.gov.NPPES/
Make sure you include each supporting document requested. Once completed, your application can be mailed to the Medicare contractor in your state, who can usually process your paperwork in 60 days.
Form 855R is required for any provider who has billed Medicare in the past and would like to reassign their benefits to an eligible provider or supplier or to terminate an existing agreement. You should routinely include an 855R with any new physician application or for any physician change in reimbursement, location, or practice name.
All signatures and dates requested in the applications must be original. No stamped or copies signatures will be accepted.
Nurse Practitioners and Physician Assistants will also have to complete this paperwork in order to bill Medicare for their services.
A list of all CMS forms for physicians can be found at :
https:// www.cms.hhs.gov/CMSForms/list.asp You may also refer to www.medicare.gov to obtain forms.
Tomorrow : Applying For Medicare Reimbursement Online
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