Reactivation - JF Part B

Are you a provider or supplier who was once enrolled in Medicare and are now reestablishing a specific billing scenario?

• Reactivation
• Reactivation vs Initial Enrollment
• Provider Deactivated Due to Revalidation
• Internet-based Provider Enrollment, Chain and Ownership System (PECOS)
• Required Applications
• What a Provider Should Expect After Application Submission
• Tips

Reactivation

• A reactivation is when an individual or organization was enrolled in Medicare at one time to bill for services and is now enrolling again to bill for services rendered.
• Some examples to determine if reactivation applies may be:
  • Provider worked with an organization, left and then came back 3 years later.
  • Provider has their own practice (Sole Proprietor), terminates their practice location, and starts a new practice at a new location 6 months later.
  • Provider/Organization is termed due to non-response to revalidation. Provider/Organization submits application to restart billing after the due date for revalidation has past.
  • Provider/Organization was deactivated for not reporting a change of information in a timely manner.
  • Provider/Organization was deactivated for non-billing.

Reactivation vs Initial Enrollment

• Reactivation
  • Providers who reactivate will have the application receipt date as their effective date
    • Paper applications - Effective date is day application is received in Noridian's mailroom
    • Internet-based PECOS applications - Effective date is day last required signature is received
  • Provider is reestablishing your Medicare enrollment for a previous billing scenario.
  • Provider not required to resubmit Participation Agreement (CMS-460)
  • Provider was deactivated for non-billing
    • Must submit a completed CMS-855 enrollment application via paper or Internet-based PECOS
• Initial Enrollment
  • Provider can request effective date and normal effective date rules apply
    • Visit the Initial Enrollment webpage for details on effective dates
  • Provider is establishing your Medicare enrollment
  • If choosing to participate, Sole Proprietors, Sole Owners, and Organizations must submit Participation Agreement (CMS-460)

Provider Deactivated Due to Revalidation

• Providers/Suppliers who were deactivated due to a non-response to Revalidation request must submit a new application packet to reactivate enrollment
  • Submit a completed CMS-855 application via paper selecting Reactivate
  • Submit an Internet-based PECOS application using the Revalidate button
• Provider/Suppliers who were deactivated due to a non-response to development must submit a new application to reactivate enrollment
  • Submit a complete CMS-855 application via paper selecting Reactivate
  • Submit an Internet-based PECOS application using the Revalidate button
• During the time of non-response, no payments will be made. The time from deactivation to date application is received is also called "lapse in coverage."
• Organizations that are reactivated due to revalidation are not required to submit applications for their members

Internet-based Provider Enrollment, Chain and Ownership System (PECOS)

CMS has established Internet-based PECOS as an alternative to the paper (CMS-855) enrollment process. It will allow physicians, non-physician practitioners and provider and supplier organizations to enroll, make a change in their Medicare enrollment, view their Medicare enrollment information on file with Medicare, or check status of a Medicare enrollment application via the Internet.

Read more on CMS Internet-based PECOS webpage.

Required Applications

• Sole Proprietors: CMS-855I, CMS-588 EFT
• Sole Owners: CMS-855I, CMS-588 EFT
• Organizations: CMS-855B, CMS-588 EFT
  • Must have at least one rendering provider
    • If Provider is not enrolled, submit CMS-855I
    • If Provider is actively enrolled, submit CMS-855I

What a Provider Should Expect After Application Submission

• Application Processing Time
  • Initial paper application with onsite visit: 65-100 calendar days
  • Initial paper application without onsite visit: 30-65 calendar days
  • Initial PECOS application with onsite visit: 50-85 calendar days
  • Initial PECOS application without onsite visit: 15-30 calendar days
• When a provider application is completed, a notification letter is sent. Letter will state whether application has been approved, rejected or denied

CMS requires providers/suppliers to revalidate every five years. View the Revalidation webpage for details.

Tips

General Information

• If provider has e-signed in PECOS, do not submit paper certification statements
• Ensure correspondence address is up to date and a location that is regularly monitored
• If provider receives an email regarding being active in another state and are still active in that state, disregard. If no longer providing services in those states, send an application to terminate
  • Provider Reassigning Benefits: CMS-855I
  • Sole Owner and Sole Proprietor: CMS-855I
  • Organizations: CMS-855B

Group Member

• Complete sections 1, 2, 3, 4B, 13, and 15 of CMS 855I.
• Physician Assistants (PAs) complete sections 1, 2, 2E, 13 and 15 of CMS 855I.
• Attach all supporting documentation such as Diploma and Certification.

Organizations

• Complete all sections of CMS-855B.
• Attach all supporting documentation such as IRS document, CMS 588 EFT, and voided check/bank letter.
• List all current, active practice locations.
• List all directors, board members, and contracted or W-2 managing employee.
  • Ensure that someone is marked as a contracted or W-2 managing employee
• Fees may be required. View the CMS Application Fee Requirements Matrix to see if this applies.

Sole Owner

• Complete sections 1, 2, 3, 4A-4H, 6, 8, 13, and 15 of CMS-855I.
• Attach all supporting documentation such as Diploma, Internal Revenue Service (IRS) document, Certification, CMS-588 EFT, and voided check/bank letter.
• List all current, active practice locations.

Sole Proprietor

• Complete sections 1, 2, 3, 4C-4H, 6, 8, 13, and 15 of CMS-855I.
• Attach all supporting documentation such as Diploma, IRS document (if billing with EIN), Certification, CMS-588 EFT, voided check/bank letter.
• List all current, active practice locations.