Medicare privileges are essential to most healthcare providers and medical practices. Medicare enrollment is necessary and allows you to accept patients without other forms of insurance or the ability to pay. Medicare provider enrollment mistakes can be costly, causing you to miss out on revenue, or, worse, lose your Medicare privileges altogether. Revocation can spell death for a practice because getting cut off from that funding source can have a considerable impact.
Given how vital it is for providers to get Medicare enrollment right, a surprisingly high number make crucial mistakes. For example, failing to update Medicare provider enrollment information is expected. Though that doesn’t seem like a big deal, it can become quite costly if you become subject to extra fees, fines or have your Medicare privileges come under suspension.
There are many errors that a medical provider could make during their Medicare enrollment, but there are some more common or problematic than the rest. Here are four common and costly mistakes that medical professionals often make when enrolling for Medicare.
1. Incorrect and Missing Paperwork
You must be enrolled in the Medicare database to get your billing number and receive reimbursement. The most common way to achieve this is by filling out the CMS 855B form.
When filling out this form, it needs to be as accurate as possible. What many providers may need to realize, however, is that you must routinely resubmit this form to recertify its accuracy and make necessary updates to the information. If you don’t, you will be unable to maintain your Medicare billing privileges. You should update this form (CMS 855B) with current information every five years or more often if changes occur. This leads us to the following common mistake.
2. Failure to Update Information
It can seriously harm your healthcare practice if you fail to update information relevant to your Medicare enrollment, either as it happens or when you hit that five-year mark. Failure to update critical information by accident could make you liable for a fraud or abuse suit.
3. Claiming an Incorrect Practice Location
Claiming false or outdated information on your paperwork can result in an audit, which is anything but cheap. According to CMS reviews, about half of online provider directories need to be more accurate, with incorrect addresses and phone numbers topping the list. Though a directory mistake is terrible enough, erroneous information on the enrollment application is far worse.
For example, 11% of the location fields on Medicare provider enrollment forms are reported empty or inaccurate. A significant cause of inaccuracy is mixing up mailing and location addresses. A P.O. box is not valid to use as your healthcare practice’s location and may result in fines, sanctions, or revocation of privileges if listed. CMS may catch the error when reviewing your application, or they may send an auditor to your physical location.
“If CMS or one of its contractors visits your practice location and finds it is no longer being used or is a post office box, but the practice location is still on your Medicare enrollment, your Medicare billing privileges will be revoked.” Source: Tafp.org
4. Ignoring a Warning or Notice
If you receive an official warning notice from the Medicare office or CMS, it means that whoever filed the paperwork made some mistake. If the government sends you a letter containing a warning or notice regarding incorrect Medicare provider enrollment information, you cannot disregard it. Instead, you can just complete and file a corrective action plan CAP to show that you are aware of the problem and have begun taking steps to fix it. Later, you can file a motion for reconsideration and petition CMS to reverse any sanctions they may have placed on you.
“CMS can and will revoke or deny enrollment to physicians who do not comply with Medicare regulations.” Source: Tafp.org
How We Can Help With Medicare Enrollment
Accurate Medicare enrollment isn’t just time-consuming — it’s vital to the continuance of your practice. Failure to enroll properly in the Medicare system, or making a mistake while doing so, can harm your healthcare career, medical practice, or both. Nobody looks forward to endless paperwork, and you can’t wait to get done with filling out forms. Yet “getting it over with” or allowing unqualified people to handle it is how costly mistakes can occur.
We have an experienced team of experts at Primoris Credentialing Network. We work together to make provider enrollment as quick and straightforward as possible. We help you enroll with the most accurate information available while doing our best to keep your enrollment process as painless as possible.
Improper provider enrollment can end up costing you time and money that you don’t have to spare. That’s why we make the process quick and painless, providing verification that ensures a typo or oversight won’t cost you your business.
More information about Primoris Credentialing Network
Primoris Credentialing Network is a NCQA Credentialing Accredited specializing in credentialing and provider enrollment with 54+ health plan and network provider enrollment options. Primoris is a family member of Fifth Avenue Healthcare Services. Sister companies include 5ACVO (credentialing and primary source verification specialists) and Fifth Avenue Agency (MPLI and medical malpractice specialists).
For more information on Primoris Credentialing Network, please visit PrimorisCredentialingNetwork.com or Contact Us.
