Supporting Documentation Information

Supporting Documentation Information

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers on Tuesday, June 4th

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers on Tuesday, June 4th! Our first in our series of Medicare Part B 2024 Spring/Summer Virtual Conference Tuesdays is right around [...]

Hospice Billing Instructions for Influenza, Pneumococcal and Hepatitis B Vaccines

Hospice Billing Instructions for Influenza, Pneumococcal and Hepatitis B Vaccines Medicare covers influenza virus, pneumococcal and hepatitis B vaccines in accordance with coverage requirements, when furnished by a hospice to those [...]

Exemption Process for the Prior Authorization Program for Certain Hospital Outpatient Department Services

The Centers for Medicare & Medicaid Services (CMS) implemented a prior authorization program for certain hospital outpatient department (OPD) services for date of service (DOS) on or after 7/1/2020 and subsequently added an exemption process. [...]

Home Health Claims Returned to Providers with Reason Code 31755

CMS reactivated RC 31755 effective 1/3/2023 and some HH claims are being RTP due to billing errors. These claims need to be corrected with the information provided in the Provider Action section of this article. Medicare is still receiving [...]

MLN Connects® Newsletter: June 13, 2024

MLN Connects® Newsletter: June 13, 2024 News Medicare Shared Savings Program: Apply for January 1 Start Date by June 17 Men’s Health: Encourage Your Patients to Prioritize Their Health Compliance Hospital Beds & Accessories: [...]

Paper Enrollment Process

Paper Enrollment Process Enrollment via paper is an option, but PECOS is the preferred method to process the application with streamlining features. Paper-based enrollment applications are available. Determine which CMS Paper Form you will [...]

Complete All Topics

Complete All Topics Instructions for completing all PECOS topics: Select the ‘Topic View’ tab and add information in every topic Note: The electronic funds transfer (EFT) topic must be completed by: groups suppliers sole owner group [...]

Upload Supporting Documents

Upload Supporting Documents Instructions for PECOS to upload required supporting documentation: Select the ‘Topic View’ tab Select “Required and/or Supporting Documents” Upload documents Mandatory for all provider/supplier types: [...]

Resolve All Errors and Verify Warnings

Resolve all Errors and Verify Warnings Instructions for resolving all errors and warnings: Select the ‘Errors/Warning Check’ Tab.   Correct all errors identified and verify any warnings.   Related Content Resolving PECOS [...]

Verify and Manage Signature(s)

Verify and Manage Signature(s) Verify signatures on all application(s) submitted including applications that were “Return for Corrections”, by returning to the enrollment box in PECOS. Important: The reassignments are viewed by selecting [...]

Determine your Business Structure

Determine your Business Structure When starting a business, you must decide what form of business entity you wish to establish. The legal structure you choose for your business has more to do with tax, liability and management arrangements. [...]

Individual (Group Member) Reassigning Benefits Only

Individual (Group Member) Reassigning Benefits Only Download CMS-855I: Complete sections 1, 2, 3, 4, 4F, 12, 13 and 15 (B and C). Reassignment means that an individual physician, nonphysician practitioner, or other supplier has granted [...]

Ordering/Referring Provider Only

Ordering/Referring Provider Only Download CMS-855O. Complete sections 1, 2, 3, 4, 5, 6 and 8. Note: Ordering and referring providers are only required to be enrolled in one state. Be sure to include supporting documentation for [...]

Adding a New Reassignment of Benefits Using the CMS-855I

Adding a New Reassignment of Benefits Using the CMS-855I Download CMS-855I version (5/23): Complete sections 1A and B, 2A, 3, 4F (add, terminate, change reassignment), 13, and 15B and 15C IMPORTANT: If an individual is new to the [...]

Electronic Funds Transfer Agreement

Electronic Funds Transfer Agreement Download and complete the CMS-588 EFT Authorization Agreement. Physicians and nonphysician practitioners who are reassigning all of their payments to another entity are not required to submit the CMS-588. [...]

Medicare Participating Physician or Supplier Agreement

Medicare Participating Physician or Supplier Agreement Download and complete CMS-460 Medicare Participating Physician or Supplier Agreement. Note: CMS-460 must have a signature and date of participant or authorized representative of [...]

1-800-MEDICARE Authorization to Disclose Personal Health Information

Medicare Correspondence Request Form

Prior Authorization Request for Outpatient Services: Implanted Spinal Neurostimulators

Hospice Visit Reporting

Hospice Visit Reporting Table of Contents Background Discipline Visits Reporting Visits in the Routine Home Care, Continuous Home Care and Inpatient Respite Care Levels of Care Discipline Revenue and HCPCS Coding Required Detail for [...]

How to Bill When the Hospice Face-to-Face is Late from a Previous Benefit Period

How to Bill When the Hospice Face-to-Face is Late from a Previous Benefit Period Background CMS requires that a hospice physician or hospice nurse practitioner must have a FTF encounter with each hospice patient prior to the beginning of the [...]

Prior Authorization HCPCS Tool Top

Prior Authorization HCPCS Code Inquiry Tool This is a self-service tool to allow ambulance service providers, hospital, or physician office staff responsible for submitting prior authorization requests (PARs), to determine if the procedure [...]

PA Exemption Tool Top

Prior Authorization Exemption Status Inquiry Tool This is a self-service tool to allow both hospital or physician office staff responsible for submitting prior authorization requests (PARs), to check the exempt status of the HOPD. This [...]

Prior Authorization Request for Outpatient Services: Cervical Fusion

Creating application in PECOS

Creating Application in PECOS Instructions to create an application in PECOS: Login to PECOS My Associates Create Initial Enrollment Application Note: There will be a series of questions to determine application descriptions tailored to [...]

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers-Register Today for June 18th Sessions!

Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare-Tuesday Tutorials for Part B Providers-Register Today for June 18th Sessions! Our third in the series of Medicare Part B 2024 Spring/Summer Virtual Conference Tuesday’s [...]

Eligible Physicians

Eligible Physicians Physicians who can enroll in Medicare: Doctor of: Medicine (MD) Osteopathy (DO) Chiropractic (DC) Dentistry (DMD) (DDS) Optometry (OD) Psychiatry (MD) Podiatry (DPM) Reviewed 6/13/2024

Eligible Nonphysicians

Eligible Nonphysicians Nonphysician Practitioners who can enroll in Medicare. Below you can find the definition, qualifications and supporting documentation for each specialty. Visit Obtain/Verify State License for assistance with license [...]

Eligible Part B Suppliers

Eligible Part B Suppliers Suppliers who can enroll in Medicare: Ambulance Service Supplier Ambulatory Surgical Centers (ASC) Clinic/Group Practices Hospital Department(s) Home Infusion Therapy (HIT) Independent Clinical Laboratory [...]

State License and Registrations for Individuals and Organizations

State License and Registrations for Individuals and Organizations Prior to submitting a provider enrollment application to Medicare, ensure that all applicable state licensing and/or specialty certification requirements are current. Each state [...]

How to Submit a Hardship Request

How to Submit a Hardship Request To request a hardship consideration, submit with a letter and any supporting documentation describing the hardship and why it justifies the exception for your application. Your hardship request will not be [...]

How to Obtain a Refund

How to Obtain a Refund A refund will only be granted in the following instances: The application fee was not required for the application submitted A hardship request was subsequently approved and a fee was paid An application was [...]

Electronic Funds Transfer

Electronic Funds Transfer EFT allows for claim payments to be electronically transferred to your bank in place of a hard copy check mailed to the facility. Medicare payments due a provider or supplier of services may be sent to a bank (or [...]

Electronic Funds Transfer Form and Instructions

Electronic Funds Transfer Form and Instructions To initiate the EFT process, you will need to complete the Electronic Funds Transfer (EFT) Authorization Agreement (CMS-588). By signing the CMS-588 form, you are certifying the account is in [...]

Verify Bank Account Information

Verify Bank Account Information National Government Services receives numerous electronic funds transfer banking rejections each year due to frozen or closed bank accounts. To prevent interruption in Medicare payment, billing providers verify [...]

Acknowledgement Email

Acknowledgement Email Upon receipt of your application submission, the contact person (identified on application) will receive an email confirmation from: CustomerService-DoNotReply@cms.hhs.gov containing the PECOS web tracking number. [...]

Requests for Additional information

Requests for Additional information While processing the application(s), National Government Services may determine additional information is needed. All requested information should be submitted as soon as possible, but no later than 30 days [...]

Site Visits

Site Visits Site visits may be required and will be unannounced; the contractor representatives must disclose to the provider appropriate identifying credentials and explain the purpose of the visit. CMS has implemented a site visit [...]

Requests for Additional Information

Requests for Additional Information While processing the application(s), National Government Services may determine additional information is needed. All requested information should be submitted as soon as possible, but no later than 30 days [...]

Requests for Additional Information

Requests for Additional Information While processing the application(s), National Government Services may determine additional information is needed. All requested information should be submitted as soon as possible, but no later than 30 days [...]

Individual Medicare Enrollment Private Practice (Sole Proprietor) via SSN

Individual Medicare Enrollment Private Practice (Sole Proprietor) via SSN Download CMS-855I. Complete sections 1, 2, 3, 4, 6, 8, 12, 13 and 15B. Note: Be sure to complete sections 4, 4A, 4A3, 4B, 4C, 4D and 4E. If reassigning benefits [...]

Individual Medicare Enrollment Private Practice (Sole Proprietor) via EIN

Individual Medicare Enrollment Private Practice (Sole Proprietor) via EIN Download CMS-855I: Complete sections: 1, 2, 3, 4, 6, 8, 12, 13 and 15B. Notes: Be sure to complete section 4, 4A, 4A3 (enter employer identification number) 4B, [...]

Individual Medicare Enrollment Sole Owner of a Corporation via Tax ID

Individual Medicare Enrollment Sole Owner of a Corporation via Tax ID Download CMS-855I: Complete sections 1, 2, 3, 4, 6, 8, 12, 13 and 15. Notes: Corporation structures: examples are PA, PC, LLC, PLLC, Inc., etc. Be sure to complete [...]

Physician Assistant

Physician Assistant Download CMS-855I Complete sections 1, 2, 3, 4, 4F, 12, 13 and 15B Note: Submit the required supporting documents including the NCCPA and diploma. Reviewed 6/13/2024

Supporting Documents

Supporting Documents Attach required supporting documentation for individuals or organizations. Submit all applicable documents: CMS-588 EFT Authorization Agreement and voided check or bank confirmation letter IRS document confirming your [...]

Medicare Information in Other Languages

Medicare Information in Other Languages Download Medicare & You in Spanish, 中文/Chinese, TIẾNG VIỆT/Vietnamese or 한국어/Korean. Español/Spanish  中文/Chinese  한국어/Korean  TIẾNG VIỆT/Vietnamese   Reviewed 6/13/2024

Sign and Submit the Application(s)

Sign and Submit the Application(s) In order to send your application, after resolving all errors, you must select “Begin Submission” which is available from any of the tabs (Topic View, Fast Track View, Error/Warning Check). Instructions for [...]

Medical Review: Targeted Probe and Educate Review Topics

Medical Review: Targeted Probe and Educate Review Topics Prevent technical denials by ensuring your medical records are legible and include a valid, legible provider signature. If you notice the provider signature is illegible when asked to [...]

Medical Review: Targeted Probe and Educate Review Topics

Medical Review: Targeted Probe and Educate Review Topics Prevent technical denials by ensuring your medical records are legible and include a valid, legible provider signature. If you notice the provider signature is illegible when asked to [...]

Medicare Part B Coverage and Billing Guidance for Breast Ultrasound

Medicare Part B Coverage and Billing Guidance for Breast Ultrasound Breast ultrasound uses sound waves to produce pictures of the inside of the breast and can show changes that are more difficult to see on a mammogram. Breast ultrasound is not [...]

Site Visits

Site Visits Site visits may be required for certain providers and will be unannounced; the contractor representatives must disclose to the provider appropriate identifying credentials and explain the purpose of the visit. The CMS has [...]

PECOS Self-Service Application Status

PECOS Self-Service Application Status You may run simple search queries to retrieve and view the status of your PECOS application. Individual ‒ View the enrollment application status of an individual provider in an organization or private [...]

Check Provider Enrollment Application Status

Check Provider Enrollment Application Status You may run simple search queries to retrieve and view the status of your CMS-855 application via two options. Case number/web tracker id NPI and TIN combination Related Content Check [...]

Interactive Voice Response System

Interactive Voice Response System You may check the status of your provider enrollment application (PECOS or paper) submissions via the IVR by: Case number/web tracker id or NPI and TIN combination Related Content Interactive Voice [...]

Approval or Denial

Approval or Denial Approval Once your application is approved, you will receive an emailed, faxed or mailed Medicare letter with PTAN. Review this letter to ensure that everything is accurate and if you have any questions, please contact the [...]

Approval or Denial

Approval or Denial Approval Once your application is approved, you will receive an emailed, faxed or mailed Medicare letter with PTAN. Review this letter to ensure that everything is accurate and if you have any questions, please contact the [...]