855B Enrollment & Policy Overview

1 855B Enrollment & Policy OverviewJoanne M. Lucas, , Business Function Lead CMSA ndrea King, Education SpecialistNovitasSeptember 2017 Session Overview Examine who should complete the CMS-855B Pr ovide a comprehensive Overview of the CMS-855B application and the PECOS equivalent Explore the benefits of PECOS vs paper-based application Analyze Ownership and Managing Control; Organizations and Individuals Review Medicare Enrollment of IDTFs, ASCs, and Ambulance companies 2 What is the 855B? The CMS form used for the Enrollment of Clinic/Group practicesand Certain Other Suppliers. This form is also used to submit changes to your Enrollment data.

2 3 Benefits of using PECOS vs. Paper We encourage you to use PECOS instead of paper Medicare Enrollment applications Advantages of using PECOS include: Completely paperless process, including electronic signature and digital document feature Faster than paper-based Enrollment Tailored application process, meaning you only supply information relevant to your application and specialty More control over your Enrollment information, including reassignments Easy to check and update your information for accuracy Less staff time and administrative costs to complete and submit Enrollment to Medicare 4 Getting Started The CMS-855B Application You can find the paper application at the following link: should complete the CMS-855B or the PECOS equivalent?

3 Clinic/Group practices Ambulance Service Supplier Ambulatory Surgical Center Independent Diagnostic Testing Facilities Portable X-Ray Supplier Hospital or medical practice that may bill for Medicare part A services but will also bill for Medicare part B practitioner services6 Currently enrolled with a Medicare FFS contractor but need to enroll in another FFS contractor s jurisdiction Currently enrolled in Medicare and need to make changes to your Enrollment dataSection 1A Basic Information Reason for Application BE SURE TO INCLUDE YOUR NPI AND MEDICARE IDENTIFICATION NUMBER, IF ISSUED, ON THE APPLICATION!7 Section 1B Basic Information (Continued) All applicants must complete this section If you are Changing, Adding, or Deleting Information, a Change of Information should be submitted8 Section 2A - Identifying Information Type of Supplier 9If you are more than one type of supplier, you MUST submit a separate application for each type.

4 Additionally if you change the type of service that you provide, you must also submit a new application. Section 2B1 Business Information If there is another name that the provider uses ( , a former legal business name, a DBA or doing business as name, etc.), then this should be listed under Other Name and check the appropriate box. 10 Section 2B2 State License Information 11 Section 2B3 Correspondence Address Contact Information is VERY important because this is where the MAC will be sending important letters and documents directly to the provider! 12 Section 2C -Hospitals Only13If you are a hospital that plans to bill separately for each hospital department, ensure you separately list each department, Medicare identification number, and NPI.

5 Section 2E Physical Therapy (PT) and Occupational Therapy (OT) Groups Only If any of the responses to the listed questions is yes , then you must submit a copy of the lease agreement that gives the group exclusive use of the facility for PT/OT services. 14 Section 2F Accreditation for Ambulatory Surgical Centers (ASCs) Only 15 Section 2G Termination of Physician Assistants (Only) 16 Section 2H Advanced Diagnostic Imaging (ADI) Suppliers 17 Section 3 Final Adverse Legal Actions/Convictions18 Section 3 Final Adverse Legal Actions/Convictions19 Section 3 Final Adverse Legal Actions/Convictions (Continued) 20 Section 4A Practice Location Information Practice Location Effective Date 21 Section 4A Practice Location Information Provide the specific street address as recorded by the Postal Service.

6 Do not furnish a Box number. Be sure to enter the Medicare identification number and NPI, if issued. 22 Section 4B Where do you want Remittance Notices/Special Payments Sent? Anyone enrolling in Medicare or changing information on their Enrollment file must use an EFT. (CMS-588 FORM) 23 Section 4C Where Do You Keep Patients Medical Records? Boxes and Drop Boxes are not acceptable to list as where the records are maintained!24 Section 4D Rendering Services in Patients Homes 25 Section 4E Base of Operations Address for Mobile or Portable Suppliers The base of operations is the location from where personnel are dispatched, where mobile/portable equipment is stored, and when applicable, where vehicles are parked when not in 4F- Vehicle Information If more than two vehicles are used, copy this section and complete it for each additional vehicle.

7 27 Section 4G Geographic Location for Mobile or Portable Suppliers Base of Operations 28 Section 5 Ownership Interest and/or Managing Control Information Organizations 29 Section 5, Organizations Only All organizations that have any of the following must be listed in section 5A of the Form CMS-855: A 5 percent or greater direct or indirect ownership interest in the provider Mortgage or security interest Managing control of the provider or supplier Any general partnership interest in the provider, regardless of the percentage (For limited partnership, any interested greater than 10%)30 Financial Control DefinedFinancial control exists when: An organization or individual is the owner of a whole or part interest in any mortgage, deed of trust, note, or other obligation secured (in whole or in part) by the provider or any of the property or assets of the provider.

8 And The interest is equal to or exceeds 5 percent of the total property and assets of the Control of The Provider or Supplier A managing organization is one that exercises operational or managerial control over the provider; Or conducts the day-to-day operations of the provider The organization need not have an ownership interest in the provider32 Examples of Managing Organizations Corporations Partnerships and limited partnerships Limited liability companies Charitable and religious organizations Governmental/tribal organizations Medical staffing companies Banks and financial institutions Investment firms Holding companies Trusts and trustees Medical providers/suppliers Consulting firms Management services companies Non-profit entities 33 Section 5A Organization Identification Information 34 Section 5B Ownership Interest and/or

9 Managing Control Information (Organizations)35 Section 6 Ownership Interest and/or Managing Control Information (Individuals)36 Section 6B Ownership Interest and/or Managing Control Information (Individuals)37 Section 6, Individuals Only Who should be reported: Persons with 5 percent direct or indirect ownership interest Financial Control: Whole or part interest in any mortgage, deed, trust, note, and property assets ; and The interest is equal to or exceeds 5 percent of total property and assets Officers and Directors Managing employees Individuals with Partnership Interest Authorized Officials Delegated Officials 38 Authorized Officials Authorized Officials must be: 5 percent direct owner of provider or supplier Have ownership interest or control of provider or supplier as: President General partner Chairman of the board Chief financial officer Chief executive officer Must be reported in Section 6 and 1539 Delegated Officials Delegated individual authorized to report.

10 Enrollment changes Sign revalidation applications Has ownership or control interest or be W-2 managing employee Managing Employee: General Manager Business Manager Administrator Operational or Managerial control over operations Must be reported in Section 6 and 1640 Section 8 Billing Agency Information Applicants that use a billing agency must complete this sectionA billing agency is a company or individual that you contract with to prepare and submit your claims. If you use a billing agency, you are responsible for the claims submitted on your behalf41 Section 13 Contact Person If questions arise during the processing of this application, the fee-for-service contractor will contact the individual shown Takeaways Regarding Contact Person(s) If you have multiple contact persons listed, the first contact person will be notified if any additional information is needed If no contact person is listed, the provider will be contacted directly if any information is needed43 Certification Statement (Section 15 and 16)Faxed, Photocopies, or stamped signatures are not considered original!