Provider Enrollment Ask-the-Contractor Teleconference (ACT)
View the handout for the June 23, 2021, Provider Enrollment Ask-the-Contractor Teleconference (ACT).
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- Do we have to re-enroll if we want to change our tax ID? There is no change in owner - we are just wanting to change our tax ID. We are a Part B clinic.
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Yes, an initial enrollment application must be submitted under the new Tax ID. Once the application process is completed, the provider will be issued a new PTAN for the new Tax ID. Also, the provider will need to terminate the old PTANs under the old Tax ID.
Published: 07.06.21
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- What is the impact of changing a solo provider's enrollment from SSN to Tax ID?
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A sole proprietor must enroll under their SSN but can bill Medicare either using their SSN or EIN.
Published: 07.06.21
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- Has CMS resumed requirement for completing revalidations on the revalidation cycle?
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No, the revalidation has temporarily ceased during the public health emergency.
Published: 07.06.21
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- Could you explain how to apply for a PTAN in another state for telehealth visits?
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Telehealth providers need to enroll in the state where they are physically located and are only required to be licensed in that state. If they are a member of a group, the group must enroll in with the MAC whose jurisdiction handles the state where the telehealth provider is physically located, and they are to identify the address where the provider is physically performing the telehealth service from(including if it's their home address).
Published: 07.06.21
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- For telehealth, do I need to enroll our group in the state where the provider is located as well? Meaning both the group and the individual provider need a PTAN for the correct state?
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Yes, the group must enroll in with the MAC whose jurisdiction handles the state where the telehealth provider is physically located, and they are to identify the address where the provider is physically performing the telehealth service from.
Note: At this time CMS has not decided if Medicare is going to allow providers to work remotely after the public health emergency.
Published: 07.06.21
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- We will be opening a new FQHC in the next few months. Can you go thru the initial process for enrolling with Medicare?
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Before the FQHC submits the CMS-855A form for initial Medicare enrollment, the FQHC must be open and operational. The FQHC will need to supply the required attestation form (Exhibit 177) from HRSA, confirming the FQHC was open and operational before we can approve Medicare enrollment.
Reference: Medicare Program Integrity Manual, Chapter 10, Section 10.2.1(D)
Published: 07.06.21
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- If our original application was on paper, can we do a change of owner ship online?
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Yes.
Published: 07.06.21
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- Is there any additional paperwork to fill out for the new systems in July?
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We are not aware of any new system coming in July. This may be Medicaid related.
Published: 07.06.21
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- Do you use the PECOS system to notify Medicare that a provider is retiring or is there a separate place to do that?
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Yes, providers would submit a Voluntary Termination (through the withdraw from Medicare process).
Published: 07.06.21
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- Medicare B, group practice – adding provider(s), which form do you use?
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The CMS-855I application should be completed if the individual is not enrolled in Medicare. Submit with the CMS-855R to complete the reassignment to the group.
Published: 07.06.21
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- We are opening a Behavioral Health Unit that will also offer OP services. Do we need a separate NPI from the hospital NPI?
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A new NPI is not needed. However, if a new NPI would help to distinguish for billing purposes, you may want to consider it.
Published: 07.06.21
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- Once a provider is added to PECOS can that information help with the managed care providers credentialing process?
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We cannot advise how managed care handles their credentialing. However, if managed care uses PECOS, it may help. We advise to speak with managed care.
Published: 07.06.21
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- Can we change from one Tax ID # to another Tax ID # within the same organization? How difficult is this change?
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For Part B only – An initial enrollment application must be submitted under the new Tax ID. Once the application process is completed, the provider will be issued a new PTAN for the new Tax ID. Also, the provider will need to terminate the old PTANs under the old Tax ID.
Part A facilities would be handled differently. The facility should contact CGS Provider Enrollment Customer Service for further guidance.
Published: 07.06.21
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