Medicare Provider Application

2014 Medicare and Medigap Updates

Medicare Provider Application

With the high demand for medical services throughout the country, there are plenty of reasons to help justify why suppliers and medical practitioners alike should consider their Medicare provider application. While application to become a certified provider is not difficult, there are steps that need to be followed in order to ensure that the process goes as smoothly as possible. This post is dedicated to discussing the Medicare provider application process in order to help those that are interested in becoming certified Medicare providers.

Consider the following steps in Medicare provider application:

1. Apply for a National Provider Identifier. This is a 10-digit number that identifies you and your business as a unique provider of medical services for the government and its accompanying functions. The great thing about getting an NPI is that it is free and the forms can be filled out online or via paper and then mailed to the Centers for Medicare and Medicaid Services offices. This ensures that those who want to go through the Medicare provider application process have multiple avenues afforded to them to seek formal approval for their application.

2. If the provider is a sole proprietor of the business, only one NPI is needed before proceeding to the next step of the process. However, if the business is a corporation or a limited partnership, both the business and the practitioner will require separate NPIs to distinguish them as separate entities.

3. Once the NPI has been issued, typically after 10-days of receipt of the application, one can now complete CMS Form CMS-855. This is the enrollment form for the Medicare provider. It should be properly noted that in the case of a sole proprietor, form CMS-855i should be used instead.

4. Those who want to go through the Medicare provider application process must see to it that all fields of CMS-855 or 855i forms are properly and thoroughly filled up. Erroneous data is sufficient grounds to reject the application, if not ban the provider from seeking Medicare provider applications in the future.

5. Submit the form to the corresponding CMS office in your area. The CMS website provides a comprehensive listing of the authorized carriers or centers that will process the application. The whole processing period should last about 60 days.

6. Once you have a response from the carrier that your application is approved, you will need to decide if you want to be a participating provider or a nonparticipation provider. There are serious implications to each decision, one that CMS is better equipped to answer. In a nutshell, and only as an overview, participating providers can accept Medicare reimbursement as the primary form of payment but they cannot send additional billing to Medicare patients. The advantage however is that participating providers generally have a 5% higher reimbursement rate than non-participating providers and that payment is done directly by Medicare.

The Medicare provider application process is fairly straightforward and is certainly a great goal for those in the medical services industry. Check it out and expand your business by becoming a Medicare provider today.

Though our site is mainly targeting those interested in Medicare supplement insurance, we do like to add other articles such as this one for any readers interested in the subject of Medicare provider application.