Medical Care Help Center.

Learning the Enrollment Application Process for Medicare

If a facility is to receive payment for procedures covered by Medicare, the facility must enroll in the Medicare program. Medicare was created and is issued by the federal government and it is a form of medical insurance for citizens age 65 or older. In order to receive payments from Medicare, the facility is required to complete a form titled “Medicare Enrollment Application for Institutional Providers” (CMS-855A). There are several ways that the facility can submit their application once they choose to enroll in the Medicare program.

There is information titled the “Provider Enrollment Packet” that the facility can request. This packet provides the step by step instructions needed to complete and submit the CMS-855A application. By logging on to the Centers for Medicare & Medicaid Services (CMS) website, the facility can also electronically submit the application. On the website they can download the application to print, or just electronically submit it.

If the facility is not a Medicare provider yet, and has not yet received Medicare payments directly into a bank account, then an electronic funds transfer (EFT) must be submitted with the CMS-855A application. Information about submitting funds electronically is given in the electronic data interchange (EDI). In order for the application to be processed, this form must be submitted with the CMS-855A application.

In addition to the enrollment application, the CMS-855A is required for any changes. These changes include any changes in billing or telephone information, any additional locations, change of ownership, stock transfer, or reactivation of an old Medicare provider number. This also includes changes of address, business name, financial information; as well as changes in management or facility directors.

Any facility that chooses to accept patients with Medicare insurance will receive a National Provider Identifier (NPI). This is a number that must be submitted on each application so the review process can be as quick and efficient as possible. Before submitting the CMS-855A forms, the NPI number should be requested.  Any forms without the NPI number will not be processed until the NPI is submitted.

Upon submission of all information and applications, the forms are reviewed for approval. To ensure that providers receive prompt payment for services rendered under Medicare, all information on file must be kept up-to-date. The person that reviews the CMS-855A form is an audit intermediary (AI). They also review the Medicare provider’s cost reports to decide what the final settlement of the cost report will be. This review helps to provide payment only to facilities that are operating within Medicare’s guidelines and costs. To ensure that facilities are only billing for services rendered, and that patients are receiving Medicare-approved services, any payments for services provided under Medicare are closely scrutinized.

The detailed application process for Medicare ensures that facilities who apply for Medicare payments have high standards. So, they are eligible to be a Medicare provider. These standards allow for Medicare recipients to receive the best care possible when a medical situation arises.

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