What Providers Need to Know About the 2024 Updated Medicare 855 Enrollment Form

1. 1 Navigating the 2024 Medicare Enrollment (855) Updates PRESENTED BY: TONI ELHOMS CCS, CPC, CPMA, CRC, AHIMA-APPROVED ICD-10-CM / PCS TRAINER

2. Toni Elhoms, CCS, CRC, CPC, CPMA, AHIMA Approved ICD-10-CM/PCS Trainer 2 ❑ CEO – Alpha Coding Experts ❑ Podcast Host – Alpha Coding Podcast ❑ National Speaker - Coding, Compliance, and Reimbursement SME ❑ Former President of Orlando, FL AAPC Chapter ❑ Expert Witness ❑ Published Author ❑ Consultant/Educator/Trainer

3. 3 Agenda What is up with PECOS 2.0? Discuss the 2024 Medicare Enrollment Updates including discontinuation of 855R Review common challenges with form submissions (855-B and I) Compliance Considerations Q&A at the end

4. 4 855 B - Clinics/group practices and certain other suppliers 855 A - Institutional providers CMS-855 Form Types 855 I - Physicians and non- physician practitioners 855 R - Reassignment of benefits

5. Workflow for Enrollment 5 Gather all provider contact information and credentialing documentation Login/Register for NPPES – National Plan and Provider Enumeration System PECOS - Provider Enrollment, Chain, and Ownership System OR CMS 855 Forms Provider/Practice NPI – National Provider Identifier Number

6. Methods for Enrollment 6 CMS 855 Paper Forms • Submit appropriate paper CMS 855 Form • Mail supplemental docs with paper application PECOS online portal • Surrogate or Provider NPPES login • Include supplemental docs as attachments

7. Important Terminology 7 ❑ Authorized Official – work in PECOS for them and meet regulatory definition ❑ CEO, CFO, Board Chair, Owner ❑ Access Manager (Formerly Delegated Official) – manage all business functions and staff-end users, connections, and surrogates for the organization ❑ Must be approved by Authorized Official ❑ Staff End-User – authorized to make specific changes/updates on behalf of the organization ❑ Surrogate - authorized to act on behalf of the organization

8. Surrogate Program 8 ❑ Enroll in PECOS Identity & Access Management System (I&A) ❑ NPPES ❑ PECOS ❑ Incentive Payments ❑ Requires a paper surrogacy application for CMS to review ❑ Approved – send a request for access to the provider, and the provider must approve the request ❑ Denied – reapply immediately ❑ Add, modify, and terminate providers from your group login ❑ Comply with access rules for the PECOS Identity & Access (I&A) Management System ❑ Choose your designation: Authorized/Delegated Official (AO/DO) or Staff End- User ❑ Manage organizational and individual practitioner enrollments in PECOS ❑ Manage your provider NPI records within the NPPES system ❑ Add, terminate, and authorize staff as PECOS users to streamline workflow

9. 2024 Medicare Enrollment Update 9 ❑ CMS will allow MFTs and MHCs to enroll in Medicare and bill as mental health professionals – greatly expanding access to BH Providers ❑ 400,000 LMFT and MHCs professionals are now able to get paid and render services to Medicare Beneficiaries ❑ Goes into effect on January 1, 2024 ❑ Requires 2 years of clinical supervised experience to enroll in Medicare ❑ Make sure NPI Number is linked to the correct Taxonomy code ❑ Consolidation of 855R and 855I enrollment forms ❑ The National Supplier Clearinghouse (NSC) no longer processes DMEPOS enrollment applications for Medicare ❑ DMEPOS East and West Contractors now process all enrollments

10. Entity Types 10 Entity Type 1 – Individual Providers – Provider’s SSN Entity Type 2 – Organizational Providers – EIN of entity

11. Most Common Errors 11 Missing Signatures Missing Dates Signatures must be original and signed in BLUE INK E-sign or copied signatures

12. Most Common Errors 12 Person signing the form is not a Delegated or Authorized Party Wrong CMS 855 Form Type Providers / Groups don’t terminate their reassignments Missing Revalidation Deadline because letter went to provider’s home

13. Best Practice Tips 13 Attention to detail is imperative and staying organized Have someone else review the application several times over Include all supporting documentation required Vet your vendors if outsourcing/proper training if insourcing Setup Tickler system to remind you of Revalidation Due Dates

14. Best Practice Tips 14 Information must be accurate and consistent Typed Answers and Live Signatures Respond timely to information requests Don’t miss revalidation deadlines

15. Compliance Considerations 15 ❑ Are you using a billing company? ❑ Section 8 ❑ Are your NPPs billing incident to your physicians? ❑ All NPPs need to be enrolled ❑ Do you have specialists or multi-specialty? ❑ Specialty designations ❑ Taxonomy linkage between NPPES and CMS ❑ Providers opted out of Medicare or enrolled solely to order, certify, and prescribe do not have to revalidate

16. 16 Navigating Medicare PECOS 2.0 Updates Register Now