Determining how to complete each section of the CMS-855 Medicare credentialing application can be cumbersome without a little help. Last week, we showed you how to complete sections 1-3 of the form so you can get your providers enrolled and paid faster.
This week, take a look at how to complete sections 4-17 of the Medicare credentialing form so you’ll be on your way to faster approvals.
Are You the Sole Owner? Complete Section 4A
Section 4 of the CMS-855 Medicare credentialing form is quite robust, and many practices spend the majority of their time on this section. The good news is you can skip section 4A if your provider isn’t the sole owner of a professional corporation, limited liability company or professional association. If your provider is the sole owner, complete section 4A thoroughly and then move on to section 4C.
If your provider isn’t the sole owner of the organization, you can move on to section 4B, which allows the provider to reassign their benefits to the actual practice.
Section 4C applies to sole owners who completed section 4A. In 4C, you’ll list all the practice location names of your business. If this is the provider’s first time enrolling, you can leave the Medicare identifying number field blank or write “pending” in it.
As for section 4D, only complete this if you see patients in their homes. If you don’t provide services in patients’ homes, you can skip this section.
You’ll only complete section 4E if you want remittance notices or special payments sent to an address other than your practice location. If you’re fine with those documents being sent to your practice address, you can skip section 4E.
Section 4F applies only to sole proprietors who want Medicare payments reported using their EIN and not their Social Security numbers. If that doesn’t apply to your provider, skip section 4F.
The final section 4 page, known as 4G, allows you to notify CMS if patients’ medical records are stored somewhere besides your practice location. If this doesn’t apply to you, you can skip this section.
Note that there is no section 5 on the Medicare credentialing application, and you’ll only complete section 6 if your provider is a sole proprietor. There is no section 7 on the form.
Using a Billing Service? Complete Section 8
If you contract with a billing agency to prepare and submit claims on your behalf, complete section 8. You’ll share information about that billing service in this part of the application. If you don’t use a billing contractor, don’t skip this section — instead check the first box that says, “Check here if this section does not apply,” and then skip the rest of the page.
The Medicare credentialing application does not have sections 9, 10, 11, or 12 on it.
Should You List a Contact Person in Section 13?
If the Medicare representative reviewing your application has questions about it, they’ll contact the provider directly unless you list a contact person in section 13. This may be the person who filled out the form, the practice manager or another person. If you prefer that the CMS rep contacts someone other than the provider, complete section 13.
Section 14 alerts you to the legal ramifications of falsifying information on your Medicare credentialing form, but you don’t have to complete any section of it after reading it.
Sign Section 15
The provider whose enrollment is being submitted must sign section 15, which is their certification statement. Medicare prefers that the provider sign the document using blue ink.
There’s no section 16, but when you move on to section 17, you’ll check off the supporting documents that you’re including with your credentialing application, such as the provider’s school degrees, business licenses, board certifications and any other information.
Once you complete this final section, go over your application one more time to ensure everything looks right, and then you can submit your documentation and application.
Faster Medicare credentialing is possible if you have an expert on your side! Let Yesenia Servin, CPMSM, PESC, walk you through the application during her online training, 855I Medicare Enrollment Form, Master New Changes to Get Paid. Register today!
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