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Is your Medicare practice information up-to date?



March 13, 2015

The February issue of CMA Practice Resources (CPR) contained an article discussing the importance of maintaining up-to-date practice demographic information with contracted managed care payors (see “Ensure your practice information is up-to-date with contracted payors”). This advice applies equally to government payors, such as Medicare, that you are enrolled in. 

Medicare administrative contractors (MAC), such as Noridian in California, obtain practice contact information from a practice’s Medicare enrollment application, from either the Internet-based Provider Enrollment, Chain and Ownership System (PECOS), or through a paper application. The MAC may contact you by mail, telephone or email, when necessary.

 

Outdated information may cause delays in payment, and even deactivation of your enrollment status if required actions, such as revalidation, are not completed timely. For example, some physicians recently received notices from Noridian that their National Provider Identifier (NPI) was being deactivated due to lack of response to a revalidation request. While Medicare did send a paper notice to affected physicians, in many cases, the practice had not updated its contact information with Medicare, and the paper notice went to the wrong address.

 

Most government payors require completion of enrollment forms for updates and changes. To ensure your practice’s information is up-to-date with Medicare, practices are encouraged to do the following:

 

  • Complete the appropriate enrollment forms through the Internet or on paper to report changes. Changes generally cannot be made by letter.
  • Complete any necessary forms to notify the contractor of changes in your office’s primary point of contact. Many agencies will speak only to the person enrolled, or the primary point of contact on the enrollment form. If you are not the contact, they may not assist you when needed.
  • Notify the MAC or other government contractor of changes in address through the enrollment update process, even if it is to a different suite in the same building.
  • Complete an enrollment update if your correspondence address changes, even if your physical address remains the same.
  • Update all email addresses if they change. Government payors are often using email to contact physicians for needed information. Don’t forget to check your spam or junk folders for any emails that may come from contractors you submit claims to.​

 

The Medicare link to paper enrollment forms and the Internet-based PECOS can be found on the Centers for Medicare and Medicaid Services (CMS) Medicare Provider-Supplier Enrollment page on the CMS website (see left sidebar). Click here for additional information on using the Internet-based PECOS.

 

Updates may take as little as 30 days, or as long as 120 days. Once the change is completed in the system, the physician will receive written confirmation. Prompt notification to government payors of any change will help ensure there are no disruptions in enrollment or payment for your practice.

 

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