How Do I Become A Medicare Provider

The Easy Way To Get Your Credentials

Obtaining your credentialing as a home health agency can be a long, tedious process. Waiver Program requirements vary from state to state. Not only are we familiar with the various state programs, we will take the time to fully explain the benefits your agency will enjoy when you enroll in your states various Waiver Programs.

Every state offers a slate of medical and non-medical Long Term Living Support Services and Home Community Based Services . Federally-approved state Waiver Programs allow in-home care and treatment for people with a traumatic brain injuries, intellectual or similar disabilities, spinal cord injuries or other serious disabilities. Credentialed home health care agencies can provide cost-effective community-based services to eligible consumers.

Submit The Following To The Fiscal Intermediary

The Provider/Supplier Enrollment Application Form is a requirement of the application process. To obtain this form, click on the CMS-855 link above or call the fiscal intermediary at 696-0705 or visit their website at www.palmettogba.com/medicare. The CMS-855A form, along with its required documentation, and proof of payment of the application fee, are to be returned directly to Palmetto GBA, not ODH. ODH cannot process your application until this approval has been received from the Fiscal Intermediary. It may take up to 6 months for ODH to receive this approval.

What If I Am Employed By The Department Of Veterans Affairs The Public Health Service Or The Department Of Defense/tricare

These physicians will need to enroll in Medicare using a new CMS 855O Form to continue to order or refer items or services for Medicare beneficiaries. The CMS 855O Form is an an abbreviated enrollment process, which includes the following:

• Completion of the CMS FORM 855O
• Submission of the completed form along with a cover letter stating that the physician is enrolling for the sole purpose of ordering and referring items or services for a Medicare beneficiary to other provider and suppliers and cannot be reimbursed for services performed.

Upon completion, the physician should mail the cover letter and the completed form to the physicians designated Medicare enrollment contractor. Additional instructional materials can be found at:

You May Like: Is My Spouse Covered Under My Medicare

Become A Medicare Provider Or Supplier

Ready to become a Medicare provider or supplier? This guide will help you enroll in three steps.

Do not use this guide if

• Youre a DMEPOS supplier. DMEPOS suppliers should follow the instructions on the Enroll as a DMEPOS Supplier page.
• Youre an institutional provider. If youre enrolling a hospital, critical care facility, skilled nursing facility, home health agency, hospice, or other similar institution, you should use the Medicare Enrollment Guide for Institutional Providers.

Use this guide if any of the following apply:

• Youre a health care provider who wants to bill Medicare for your services and also have the ability to order and certify.
• You dont want to bill Medicare for your services, but you do want enroll in Medicare solely to order and certify.
• You wish to provide services to beneficiaries but do not want to bill Medicare for your services.
• You want to enroll as a supplier who does not dispense or furnish durable medical equipment, prosthetics, orthotics and supplies .

Keep Your Information Current

Its important to keep your enrollment information up to date. To avoid having your Medicare billing privileges revoked, be sure to report the following changes within 30 days:

• a change in ownership

Determine Eligibility As Medicare Provider

Determining your eligibility as a Medicare provider is the next step. To be eligible, you may need to be certified with the Conditions of Participation. The Centers for Medicare and Medicaid Services relies on state agencies to determine the eligibility of most providers. Check with your State Survey Agency to get more information about eligibility requirements.

Recommended Reading: Where Can I Go To Sign Up For Medicare

Determining Your Eligibility As A Medicare Provider

Applying As A National Medicare Provider

Don’t Miss: Does Medicare Offer Gym Memberships

Medicare Application Process And Forms

The Centers for Medicare and Medicaid Services determines whether a provider can participate in the Medicare program with the help of its regional home health intermediary. The Ohio Department of Health also assists CMS in making this determination by compiling information and, based on the information ODH collects, recommending to CMS whether the provider should be approved to participate. ODH uses the application process described below to compile information and make the recommendation. This approval is also a prerequisite for participation in the State Medicaid program as well. Please note that you cannot claim provider reimbursement for services furnished prior to your approval.

MEDICAID CERTIFICATION is administered by the Ohio Department of Medicaid . An application for Medicaid certification can be requested by calling ODM at 686-1516.

How Do I Become Medicare Accredited

Applying to become a Medicare provider

Ceres Sumner

Recommended Reading: How To Get Medicare Insurance License

License For Use Of Dental Procedure Codes Fourth Edition

End User Point and Click Agreement

THE LICENSE GRANTED HEREIN IS EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. BY CLICKING BELOW ON THE BUTTON LABELED I ACCEPT, YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT.

IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK BELOW ON THE BUTTON LABELED I DO NOT ACCEPT AND EXIT FROM THIS COMPUTER SCREEN. IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THIS AGREEMENT CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. AS USED HEREIN, YOU AND YOUR REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING.

Prepare For The Accreditation By Meeting The Quality Standards

After receiving your NPI, you must begin the accreditation process. But before you apply for the accreditation, make sure that you check for the various quality standards required to become a Medicare DME provider. The standards are listed in 42 Code of Federal Regulations, Part 424, Section 57. You will find every single detail about the DME provider set of standards in the 42 CFR.

The DMEPOS quality standards are divided into two categories. The first is the set of standards which cover business service requirements consisting of administration, finances, HR, customer service, performance and safety. The second set of standards cover product-specific service requirements. As a part of the second set of standards, you will be assessed on the delivery and set-up of the DMEPOS along with training and instruction required for the equipment and follow-up done to ensure the equipment is used effectively.

After thoroughly going through the details, you must make sure that every department meets the requirements. If there is any deviance, then you must take necessary steps to ensure compliance before you fill in the form for accreditation.

Recommended Reading: Is Medicare A Social Security Benefit

Do You Recommend New Cash

Again, the answer to whether or not to become a Non-Par Provider really shouldnt be about the 15% extra you can bill. If you think your practice can thrive without treating Medicare beneficiaries, you personally dont mind being unable to treat them, and you would rather avoid the hassle of dealing with Medicare at all, then dont enroll as a new practice. You will have to hire someone to do all the billing or take the time to do it yourself.

One scenario in which I think being a Non-Par Provider makes a lot of sense is the following: You are currently a Participating Provider with Medicare and you want to transition into more of a cash-based model, but still want to be able to treat Medicare beneficiaries. The infrastructure, staff, and processes are already in place to bill Medicare, so it makes sense if you still want to treat this part of the population.

How Does A Medicare Agent Get Paid

Medicare agents dont play favorites. At TSS, our job is to provide an unbiased opinion on different insurance plans. We partner with the top carriers but we ultimately represent YOU as our client. You dont pay us anything and your premiums dont go up because youve worked with us.

We make a commission from the insurance carrier for selling their products. If you buy directly from the carrier, they keep that commission and you dont receive the customer service that youd get from an independent agency like us.

You May Like: Do You Have Dental With Medicare

Ama Disclaimer Of Warranties And Liabilities

CPT is provided as is without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. The AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. The AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with Palmetto GBA or CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

CMS Disclaimer

Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the button labeled I Accept.

License For Use Of Physicians’ Current Procedural Terminology Fourth Edition

You, your employees and agents are authorized to use CPT only as contained in the following authorized materials including but not limited to CGS fee schedules, general communications, Medicare Bulletin, and related materials internally within your organization within the United States for the sole use by yourself, employees, and agents. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services . You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. Applications are available at the AMA website.

You May Like: Are Medicare Advantage Premiums Deducted From Social Security

Ramifications Of Not Having A License

A company providing Durable Medical Equipment without proper DME licenses may be subject to civil and criminal penalties.

If employees will be setting up or installing any of the equipment being provided, its imperative that companies ensure their employees are properly license or be faced with heavy fines.

DME providers include home health agencies, DME companies, practitioners, and physicians. Even if you are a licensed home health agency of physicians/practitioner, that does not exclude you from DME licensure.

The State Board of Pharmacy of Department of Health will issue a license.

We’ll Help You Get Accreditation For Your Home Health Agency

All we need is some pertinent information about your agency, and well take it from there. Dont worry. Youll receive all the professional consultations, support and guidance you need to become a contracted Medicaid waiver agency in your state. Your home health care agency doesnt have to be accredited by Medicare to be accredited as a Medicaid waiver agency. Our clinicians will let you know whether your state requires a license to do business with Medicaid or not. Either way, well guide you successfully through the accreditation process.

Your home health care agency will be included in a regional directory once the certification process has been completed. Youll learn everything you need to know about gaining access to patient referrals, reimbursement rates and negotiating with full-time and contracted employees. Call today to learn about the enrollment process and how you can benefit from Medicare Waiver Program certification.

We serve agencies that deliver behavioral health care, home health care and hospice care services anywhere in the United States. Whether you want to expand an existing health care agency or youre ready to start a new health care business, our industry-leading Medicare accreditation assistance program is exactly what you need.

Don’t Miss: Does Medicare Cover Gastric Bypass Revision

A Detailed Guide On How To Become Medicare Certified As A Dentist

Becoming Medicare certified has become essential in the modern age and its time to understand what the process entails. The average dentist may understand the importance of doing so, but wont know where to begin. For those wanting to learn how to become medicare certified as a dentist, weve done our best to provide a detailed guide to simplify matters.

Sign up for an NPI

Before doing anything else, a dentist will need to sign up for the National Provider Identifier . This is necessary to enroll in Medicare. This process can be completed online and doesnt take long. Move forward with the official NPI application, fill in the relevant details, and send it as soon as possible. The application may have to be mailed over to the main NPI address listed on the site. Please remember, this is the first step towards becoming certified.

Fill Out the Medicare Enrollment Application

The next step is an important one and has to be managed with patience. The dentist is expected to acquire an NPI before filling out the Medicare Enrollment Application. This application can be found on the main Medicare website and is available through their online enrollment system . Take the time to go through the different steps, understand whats required, and then fill out the application. PECOS has a straightforward setup and may require additional documentation to verify certain credentials including the dentists name/address. Make sure to send this information in to move the process along.