3 How To Become A Medicare Provider In California

(doylc.com) How to Become a Medicare Provider in California - To become a Medicare provider in the state of California, you must apply online at the US Department of Health and Human Services website. The online application process is known as the Provider Enrollment, Chain, and Ownership System (PECOS) and is currently the only way to apply to become a Medicare provider in the United States. Your application for enrollment will then be reviewed and processed by a California Medicare Administration Contractor (MAC), who will notify you of your official status as a Medicare provider, usually within 60 days of submitting the application. The process takes time, but caring for patients who are Medicare recipients is essential to keeping California and its residents healthy.

• Determining Your Eligibility as a Medicare Provider

Learn the types of Medicare. Any physician or non-physician health care provider or health care provider that provides services or goods necessary for the physical and mental health of individuals receiving Medicare coverage may apply to be a provider. Depending on the type of goods or services you offer, the application process includes a number of steps to ensure eligibility. It's important to review the different types of Medicare coverage and how your clinic, practice, hospital, home health care, or medical device provider fits into each part.

Part A, or in-hospital Medicare, includes hospital treatment, long-term care facilities, home health care, and hospices.

Part B, or Medicare medical treatment, includes medical services, preventive care, medical devices, all outpatient procedures, laboratory tests, X-rays, clinical and outpatient psychiatric services, and other similar treatments.

Part C is the Medicare coverage offered by private insurance providers. Those who are eligible for Medicare can opt into the Part C plan and pay additional coverage fees if they want to expand the services and providers included in their treatment plans.

Part D covers prescription drugs.

Complete additional documentation for specialty treatments or suppliers. Providers of durable medical devices, prostheses/orthotics and accessories (DMEPOS) and providers of home health care and hospice services must provide additional information or apply through agencies other than the other Medicare coverage areas. Before submitting your application, make sure that you do not offer any of the services that may be included in these two areas.

DMEPOS suppliers must meet additional criteria to meet the requirements of the Clinical Laboratory Improvement Amendments (CLIA) in order to bill Medicare for the goods provided.

Home health and hospice providers must fill out additional forms and paperwork for vehicles and other items. These are added to the PECOS application when you identify yourself as a Home Health or Hospice Provider.

Additionally, home care and hospice providers receive Medicare provider approvals through different MACs than those covering the other parts of Medicare.

Determine your eligibility as a Medicare provider. Medicare recognizes a variety of medical providers and suppliers as necessary to meet the healthcare needs of its beneficiaries. Medicare relies on the state's medical practice licensing requirements to determine eligibility. To be licensed as a Medicare provider or provider, you must meet licensing requirements and legal permits to practice in the state of California, your county, city, and other locations

If you work as part of a clinic or hospital, your facility must be an approved Medicare provider before you apply for an individual Medicare acceptance.

You must be licensed to practice medicine and meet all state and local medical certifications as an individual and organization.

• Apply to be a national Medicare provider

Register with the National Plan & Provider Enumeration System (NPPES). You will need to create a user ID that will be used to obtain your National Provider Identifier and the same credentials will be used to log into the Provider Enrollment, Chain, and Ownership Systems (PECOS) website where you are applying to become a Medicare provider. The process is simple, but once you've chosen a user ID, it can't be changed. Evaluate the information carefully before completing it.

Obtain your National Provider Identifier (NPI). Once your username is set up in the NPPES system, you will need to request this provider number. Depending on the type of medical care you provide, you must receive an individual, organizational, or both types of NPI before you can apply to be a Medicare provider.

Type 1 NPIs are required for individuals applying for Medicare coverage.

Type 2 NPIs are required for organizations and these must be obtained before individual vendors are accepted as members of the organization.

Both types of NPI are required if you are a sole proprietor of a medical facility.

Apply online through the Provider Enrollment, Chain, and Ownership System (PECOS). You must be a state-licensed Medicare provider to be eligible to accept Medicare payments in the state of California. The process is designed as a clearly defined question and answer application. You can also find checklists for each type of Medicare provider and supplier provided by the Centers for Medicare & Medicaid Services (CMS). If you have any questions during the application process, the CMS representative is available via email or phone.

Attach all required documents. Make sure you have included all the required documentation to ensure your application is processed promptly. The Medicare application process can take three months or more, and each time you need to submit additional documents, the processing time is reset. Luckily, the PECOS system guides you through each step of the process, showing you which forms and documents are required for each.

Written certification from the Internal Revenue Service showing your tax identification number and legal business name. A letter of determination from the IRS is required for nonprofit organizations. If you are a limited liability company (LLC), you will need an IRS letter certifying that the business entity is not considered separate from the individual for tax purposes.

Any definitive documentation of adverse legal action taken against you or the practice you work for.

If necessary, provide bank information if you have an arrangement with a bank to cover outstanding Medicare payments.

Copies of Federal Drug Administration clinical laboratory improvement changes and certifications and regulatory documents for each site, vendor, and supplier, including Drug Enforcement Administration numbers, if required.

Respond quickly to requests for additional information. If you miss something, you will be contacted by CMS. Submit additional information as soon as possible to ensure your application process is completed in a reasonable time frame. You should receive emails direct if additional information is required, but you can also check the status of your application online through the PECOS system.

Pay the associated fee. Before leaving the PECOS system, you must pay an application fee. As of 2017, the cost was $560, but the fee is adjusted annually. Funds from the application fee are used by Medicare to fund ongoing improvement efforts to ensure the integrity of the Medicare system for beneficiaries.

Store EDI (Electronic Data Interchange) forms. According to the Administrative Simplification Compliance Act (ASCA), Medicare applications should almost always be submitted electronically. Some vendors have been granted exceptions, but this is very rare. EDI is the system through which Medicare providers can submit claims directly. Before you can be approved by the State of California's Medicare Administrative Contractors, you must complete the registration process with EDI.

• Obtained accreditation as a California Medicare provider

Ensure that the PECOS documentation is sent to the appropriate California Medicare Administrative Contractor (MAC). To expedite the Medicare provider enrollment process, CMS has entrusted responsibility for its providers in certain geographic regions to a number of private health plans. Once your Medicare application has been approved by CMS, they should send the documentation directly to your MAC. You can also check your progress in the PECOS system. In California, Noridian and National Government Services are the MACs that will approve your request.

Noridian Approves Medicare Part A and Part B Providers and DMEPOS Providers in the State of California.

National Government Services is the organization that processes these applications for home health care and hospice providers in the state of California.

Submit receipts to the California MAC. You will be prompted to print a certification statement within the PECOS online application system, and you must sign and mail the statement to the appropriate MAC along with a copy of your California clinical approval. You must submit the documents to the California MAC within 7 days of completing the PECOS application to be approved as a Medicare provider.

Respond to requests for additional documentation. Even though the CMS has already submitted your application with a recommendation for approval, your MAC may require additional documents or information to complete the application process. As with document requests from CMS, the faster you can respond to these requests, the faster your application process will go. You may be asked to send IRS documents, proof of identity, licenses, or other information the MAC deems necessary to determine your eligibility.

Conduct on-site visits as needed. If you are applying to become a Medicare provider on behalf of a clinic, hospital, long-term care or other healthcare facility, or as a sole proprietor, a site visit is required. Site visits are carried out by the national site visit service provider. All US Medicare site inspectors are employed by MSM Security Services, LLC or its subsidiaries Computer Evidence Specialists, LLC and Health Integrity, LLC.

The on-site inspectors present a valid ID from one of these three companies during the inspection.

Failure to cooperate with on-site inspectors may result in denial or suspension of Medicare provider status.

A site visit is not required for DMEPOS suppliers as they already meet the additional CLIA qualification.

Wait for your MAC to send your approval letter. Within 45 to 90 days you will receive an electronic confirmation from the responsible MAC as to whether your application has been accepted or rejected. If you are approved as a Medicare provider, you will receive a Provider Transaction Access Number (PTAN). Your unique PTAN is linked to your NPI number and allows you to access registration records and otherwise authenticate within the Medicare system.

Sign up for Electronic Funds Transfer (EFT) for Medicare. ASCA not only requires records to be submitted electronically, but also pays out Medicare claims electronically. Once your MAC is approved as a Medicare provider, complete the EFT form included in its package. If you have not received the EFT form, contact your MAC immediately.