The Essential Guide to Medicare Provider Enrollment

Each healthcare provider should be familiar with each aspect of medicare provider enrollment. With this, healthcare providers can bill Medicare for their services. Moreover, with their enrollment in this program, they can gain attention to a potential number of patients toward their practice and get reimbursement for their provided services. However, if are interested to know more about Medicare Provider enrollment then read this article. You will also explore the main steps of the process of how you can enrol in Medicare and what are the main benefits that you can obtain from medicare provider enrollment. 

What is Medicare Provider Enrolment?

Medicare is a federal health insurance program for US people aged 65 or older. It is one of the largest insurance programs that comprises a broad range of beneficiaries. 

Medicare provider enrollment is the process through which healthcare providers apply to receive payment for their services rendered to Medicare beneficiaries. Moreover, the registration of healthcare providers with Medicare is to become an essential part of their insurance program. The standards are set by the  Centers for Medicare & Medicaid Services (CMS). 

The process of medicare provider enrollment should be complete and accurate so providers obtain a continuous stream of revenue in the form of payments from Medicare for their covered services. 

Who is enrolled in Medicare?

Those healthcare professionals who want to provide the healthcare services which are covered under the Medicare program are enrolled in Medicare including:

• Physicians
• Therapists
• Practitioners
• Nurse practitioners
• Suppliers of durable medical equipment

Which documents are required for enrollment?

For Medicare enrollment, the following documents are required:

• NPI number
• Educational certificates
• Proof of identity
• Current state license

What are the main steps of Medicare Provider Enrollment?

The main steps of Medicare provider enrollment are as follows:

Obtain a National Provider Identifier

The first step in Medicare Provider enrollment is getting the NPI. If you have the NPI already then you do not need to get it first.

A National Provider identifier is a unique identification number which is issued to healthcare professionals who obtain reimbursements from the Medicare insurance program. 

There is a National Plan & Provider Enumeration System (NPPES) website on which you can apply for the NPI. 

Complete the Medicare Enrollment application

If you have obtained the NPI then the next step is to complete the application for Medicare enrollment. This can be done through PECOS, Chain and Provider enrollment. 

PECOS

PECOS is an online system of Medicare enrollment. By using the online process, you can experience the simplified and streamlined process of Medicare enrolment. The first thing that you should do is to create an account on the PECOS website. Moreover, you can also find different video tutorials on a website that can help you complete the enrollment process. 

Some major benefits of PECOS are as follows:

• Electronic submissions
• Checking of application status

Work with your Medicare Administrative Contractor

As soon as the application is submitted, the next step is to work with your Medicare Administrative Contractor. The MAC is specific to each region of your practice. Moreover, to process your application further, MAC also requires some additional information or you need to submit more documents. 

Keep your information up-to-date

The entire information on the enrollment should be updated regarding the changing requirements. To prevent future issues, if any change occurs then it should be reported earlier. The following changes are reported within approximately 30 days:

• Change in practice location
• Severe legal action
• Change in Ownership

However, if there are some other changes then you should report them within 90 days. 

Why Medical Provider enrollment is important in Medical Billing?

With Medicare provider enrollment, healthcare providers can get multiple benefits which are as follows:

Obtaining the Reimbursements

The enrollment of healthcare providers in Medicare insurance program is essential as they become eligible to get their reimbursements for their services provided to patients. Without enrollment, they can not bill Medicare and experience the negative effect on their practices’ revenue.

Incraesed patient access

As Medicare covers a diverse array of beneficiaries so by enrollment in this program, healthcare professionals can attract an infinite range of patients towards their practice and ultimateky gain numerous benefits. 

Compliance regulation

Medicare provider enrollment is linked with compliance assurance. This is beneficial for both patients and healthcare providers regarding their security. 

Participation in other networks

For multiple state Medicaid programs, providers are required to enroll in Medicare before their enrollment in Medicaid. This indicates that enrollment is essential and important for participation in other insurance networks. 

Ensured credibility

If patients know that the healthcare providers are professional and skilled then they remain satisfied. This also increases the patient retention rate.

Concluding thoughts 

Medicare provider enrollment is a vital component of medical billing. Those healthcare providers who want to gain the potential of their practice to get the reimbursements should have complete knowledge regarding the medicare provider enrollment. By doing this, they can make sure that they provide their healthcare services to Medicare beneficiaries and grab their attention which ultimately results the increased revenue. 

If you are looking for exceptional medical billing services or guidance related the medicare provider enrollment then Medstar Billing Services should be your ideal choice. Our team of billing experts specialises in providing the top billing and RCM services that can streamline your billing process so you get an exceptional financial outcome.

Learn More From The Related Articles:

How to Get a Medicare Provider Number
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