tci Medicare Compliance & Reimbursement - 2022 Issue Q1

Reader Questions: Medicare Enrollment Is More Than Getting an NPI

Question: Our young practice wants to take on Medicare patients. Our two physicians have National Provider Identifiers (NPI). Can we start seeing beneficiaries? Florida Subscriber Answer: No. An NPI is just the starting point toward Medicare provider enrollment; it is not a substitute for the enrollment process. “Providers still need to apply for Medicare enrollment in order to be approved for the submission of Medicare claims,” explains Part B Medicare Administrative Contractor (MAC) WPS-GHA in online guidance. “The NPI is a required data element on the CMS 855 Medicare enrollment forms. Required NPI fields cannot be...

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