Get the free Medicare Enrollment Application for Physician and Non-Physician Practitioners - gpo

This document details the requirements and processes for healthcare practitioners to enroll in the Medicare program, ensuring they have the necessary professional credentials.

How to fill out medicare enrollment application for

How to fill out Medicare Enrollment Application for Physician and Non-Physician Practitioners

1. Obtain the Medicare Enrollment Application for Physician and Non-Physician Practitioners (Form CMS-855I).
2. Read the instructions carefully to understand the requirements and sections that need to be completed.
3. Fill out the identification and demographic information, including your name, practice location, and NPI number.
4. Provide details about your medical licenses, including state, license number, and expiration date.
5. Disclose any affiliations with other healthcare organizations or practices.
6. Complete the payment information section to specify how you wish to receive reimbursements.
7. Review the application to ensure all sections are completed accurately and thoroughly.
8. Sign and date the application, certifying that the information provided is true and correct.
9. Submit the completed application electronically or via mail to the designated Medicare Administrative Contractor (MAC).
10. Keep a copy of the submitted application for your records.

Who needs Medicare Enrollment Application for Physician and Non-Physician Practitioners?

1. Physicians and non-physician practitioners who wish to bill Medicare for their services.
2. Healthcare providers who need to establish a Medicare provider number.
3. Practitioners seeking reimbursement for services provided to Medicare beneficiaries.

People Also Ask about

What are the requirements for a referring physician for Medicare?

All physicians, as well as all eligible professionals as defined in section 1848(k)(3)(B) of the Social Security Act must complete this application to enroll in the Medicare program and receive a Medicare billing number.

Does Medicare require a referring physician?

CMS requires Medicare contractors to verify the Medicare claim's ordering/referring provider meets one of the following criteria: The provider has an approved enrollment record in the Provider Enrollment, Chain and Ownership System (PECOS), or. The provider opted out of Medicare and is eligible to order and refer.

How do I enroll in Medicare as a non participating provider?

Requirements The physician or non-physician practitioner must be enrolled in Medicare or Medi-Cal. The ordering, referring or prescribing provider NPI must be for an individual physician or non-physician practitioner (not an organizational NPI).

Who is the CMS form 855I the enrollment application for?

Step 1: Get an NPI. If you already have an NPI, skip this step and proceed to Step 2. Step 2: Complete the Medicare Enrollment Application. Enroll using PECOS,i the online Medicare enrollment system. Step 3: Work With Your MAC.

What are the signature requirements for Medicare physicians?

Signature Log The printed full name of the physician or practitioner. Sufficient information to identify the beneficiary. Date of service. Signature and date by the author of the medical record entry.

What prohibits physicians from referring Medicare patients?

The Physician Self-Referral Law, commonly referred to as the Stark law, prohibits physicians from referring patients to receive "designated health services" payable by Medicare or Medicaid from entities with which the physician or an immediate family member has a financial relationship, unless an exception applies.

Does Medicare require prior authorization for referrals?

What is prior authorization in original Medicare? Original Medicare rarely requires prior authorization. The government program covers medically necessary services without requiring you or your doctor to submit special forms in advance or even a referral to see a specialist.

For pdfFiller’s FAQs

What is Medicare Enrollment Application for Physician and Non-Physician Practitioners?

The Medicare Enrollment Application for Physician and Non-Physician Practitioners is a form that healthcare providers must complete to enroll in the Medicare program. It captures essential information about the practitioner’s qualifications, practice, and billing information.

Who is required to file Medicare Enrollment Application for Physician and Non-Physician Practitioners?

All healthcare providers who wish to bill Medicare for services provided to patients must file this application. This includes physicians, nurse practitioners, physician assistants, and other non-physician practitioners.

How to fill out Medicare Enrollment Application for Physician and Non-Physician Practitioners?

To fill out the application, practitioners must provide information regarding their personal background, practice details, National Provider Identifier (NPI), and any relevant documentation. The completed form can be submitted online through the Provider Enrollment, Chain, and Ownership System (PECOS) or sent directly via mail.

What is the purpose of Medicare Enrollment Application for Physician and Non-Physician Practitioners?

The purpose of the application is to gather necessary details to verify the eligibility and qualifications of providers who wish to participate in the Medicare program and ensure compliance with Medicare regulations.

What information must be reported on Medicare Enrollment Application for Physician and Non-Physician Practitioners?

The application must report information including but not limited to the practitioner's name, Social Security number, medical license details, individual National Provider Identifier (NPI), practice address, and any history of malpractice or felony convictions.