Medicare is one of the widely available insurance programs in the U.S. It is for the senior citizens (people above the age of 65) or else for those with a special condition.
Services covered under Medicare are provided by physicians but also by non physicians and others with proper certification and licensure. This is to ensure that the Medicare services are provided by qualified individuals in the interests of the beneficiaries.
Process of enrollment
- Internet based enrollment (PECOS)
- Paper based enrollment (e.g. using forms like CMS-855)
The internet based PECOS is for all the providers and suppliers except for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS).
You may go through the following link for further information on the process of enrollment: Link
All proprietary, location and final adverse action of individual, group and diagnostic services by physician and non-physicians are to be updated within 30 days of the event. All other changes are to be reported within 90 days of the occurrence of the event.
This term means that
you accept to charge the Medicare covered individuals with only the prescribed amounts. You need to accept only the copayments and deductibles and submit the claims for Medicare beneficiaries.
You participate or not, you need to submit for the claims for all those covered by Medicare under the Social Security Act.
Benefits for the participants
- Participation fetches 5% more reimbursement than the non-participants
- The amounts will be directly paid to the service providers as the claims are assigned
- The information of the claims is forwarded to Medigap.
Enrollment and enumeration
There will be a replacement in the health care provider identifiers with National Provider Identifier in the standard health care dealings. So, prior to the Medicare enrollment, you need to get enrolled in the National Provider Identifier to proceed further for Medicare enrollment.
Enrolling in Medicare helps you to get payments and submit claims for the services offered to the Medicare beneficiaries. To apply for the National Provider Identifier hit the following link or else dial the number 1-800-465-3203 or use TTY at 1-800-6922326.