December 14, 2017
Understanding the Designation of Freestanding and Claims Only for Home Health Agency and Hospice Providers
Purpose: Have you ever had an application you sent to a MAC contractor returned saying it was sent to the incorrect contractor? Want to avoid having this happen in the future? The intent of this article is to determine who processes your CMS-855A or CMS-588 (EFT) changes so this doesn’t happen to you.
All home health and hospice (HHH) claims are processed and paid by a Medicare Administrative Contractor (MAC). The HHH MAC processes all claims for these types of providers; however, if the home health or hospice is provider based, the Medicare Cost Report (MCR) and provider enrollment activities are processed by the MAC of the provider based facility.
Existing providers –
Provider Based - If you are unsure who to submit the CMS-855A or CMS-588 to, contact the personnel at the provider based facility to find out the MAC the MCR is submitted to. The CMS-855A will be processed by the MAC of the provider based facility.
Freestanding – the CMS-855A and CMS 588 will be submitted to the HHH MAC that processes your claims.
Initial Enrollment –
Freestanding - CGS only processes CMS-855A and CMS-588 applications for freestanding home health and hospice facilities located in one of the following 16 States: Colorado, Delaware, District of Columbia, Iowa, Kansas, Maryland, Missouri, Montana, North Dakota, Nebraska, Pennsylvania, South Dakota, Utah, Virginia, West Virginia or Wyoming
Provider Based: The CMS-855A and CMS-588 for initial enrollment should be submitted to the MAC for the provider based facility.
Refer to the CMS Fee-for-Service Provider Enrollment Contact List for contact information to find where to submit your application based on the State you are located in or for the provider based MAC address information.
In the cases of electronic funds transfer (EFT) changes, the MAC that processes the MCR and provider enrollment activities must complete the review and approve the EFT changes. Once they have completed their review, they will send a copy of the approved EFT form to the HHH MAC to process and input into their Fiscal Intermediary Standard System (FISS). This is very important as claims are processed and paid by the HHH MAC. The HHH MAC cannot accept EFT changes from the provider; they must come directly from the MAC.
Please refer to the following table to identify where to file your CMS-855A and CMS-588 updates for proper processing:
HHA and Hospice Providers ONLY |
MAC MCR sent to |
MAC to file CMS-855A or CMS-588 |
---|---|---|
COI or Revalidation (Freestanding) |
HHH MAC |
HHH MAC |
COI or Revalidation (Provider Based) |
MAC |
MAC |
EFT – CMS-588 (Freestanding) |
HHH MAC |
HHH MAC |
EFT – CMS-588 (Provider Based) |
MAC |
MAC |
CHOW – Freestanding before CHOW, remaining Freestanding after CHOW |
HHH MAC |
HHH MAC |
CHOW – Freestanding now, becoming Provider Based after CHOW |
MAC |
MAC |
CHOW – Provider based, becoming Freestanding after CHOW |
HHH MAC |
HHH MAC |