For most providers, limiting oneself to only accepting cash pay patients is not practical. At some point, it becomes necessary to work with at least some select insurance companies. Reasons for this might include growing your patient census, improved continuity of care, prior authorizations approvals, referral approvals, or focusing on providing care to a particular segment of your local community. Whatever your reason for choosing to contract with payers or which payers you ultimately choose to work with, working with any insurance companies often starts with Medicare.
Create or update your NPI
If you have read my previous articles, you’ll know that before attempting to become a Medicare supplier you should already have your ducks in a row. You’ll need to have completed the licensure process, including getting copies of all of the documents that go along with it, such as your license itself, any diplomas from professional school, and any board certifications. You’ll also need to apply for a National Provider Identifier number through the National Plan and Provider Enumeration System. An NPI (National Provider Identifier) is a 10-digit numerical identifier that identifies a healthcare entity, either an individual provider or some other healthcare organization or business. If you already have an NPI, you’ll need to make sure it is up to date. It is important that prior to applying for Medicare, your NPI information, including practice types, organization names, taxonomy codes, contact information and practice locations is up to date.
The CMS operated NPI registration system, and the Medicare application system use the same information databases, including usernames and passwords. Just like everything in credentialing, completing tasks in the appropriate order and remaining organized is the key to success. At North Florida Credentialing we are meticulous. From day one that you contact us, a file is created unique for you. As we work with you, we store all of your credentials in one place so it is easy to retrieve throughout the credentialing process and as you continue to grow in the future. We do all of this, so you don’t have to. We stay up at night thinking about these logistical problems, so you don’t have to. Trust us when we say we know these types of organizational tasks can be an incredible time and resource drain for already over-worked providers.
Apply to Medicare
Once you have an NPI number and all your basic documents together you eligible to apply to become a Medicare supplier through CMS. Similar to contracting with private payers who use independent application portals such as Availity, you will need to apply to work with your Medicare Administrative Contractor (MAC) using the CMS portal system, PECOS. The application itself can be completed online or as a paper application, however the online system does allow you to upload all necessary supporting documentation along with the application and avoids the need to mail or fax documents. Because of this, turnaround times on applications are often faster online. We recommend you have digital copies of documents that need to be included with the application.
Like most things associated with getting paid in healthcare, the PECOS system and the Medicare application can be confusing at best, if not endlessly frustrating. We have the experience of completing this application many, many times. We’ve seen applications get delayed, denied, require supplemental information, or altogether require resubmission. We’ve seen every one of these problems and have the experience to best avoid them. An application submitted correctly can be approved in several days, on the other hand an application that is submitted incorrectly can take months of review and corrections. This can cost a provider or business tens of thousands of dollars in lost revenues and man hours.
Work with your MAC
Your completed Medicare application is reviewed and approved by your Medicare Administrative Contractor (MAC). Once you have submitted the initial application, all communication going forward regarding your application will likely be handled directly with your MAC.
We work for you
North Florida Credentialing is perfectly positioned to help you succeed. We have the experience, resources, and team of professionals to ensure things are done correctly the first time. Small errors, failure to keep information up to date, and delays in credentialing can cost you thousands in lost revenues, not to mention years of your life in stress. We can help with application submissions, insurance questions, billing problems, ongoing provider credentialing file management, and business development.
Lastly, I want to add that at North Florida Credentialing we believe in working with clients from start to finish. That means working with you from the time you inquire with us until you have reached your goals. Too often I have seen consulting firms take their clients money only to run away and leave their client hanging with a half-completed task and unreturned emails. You will never have to worry about that problem with us. You always have access to our cell phone, email, and if needed you can visit us in person.
