American College of Physicians: Internal Medicine — Doctors for Adults ®

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Want to enroll in Medicare? You'll need a new form

From the April ACP-ASIM Observer, copyright 2002 by the American College of Physicians-American Society of Internal Medicine.

By Brett Baker

Q: What form do I have to complete to enroll in Medicare?

A: As of Nov. 1, 2001, physicians who wish to enroll in Medicare must now use new HCFA-855 enrollment forms. In order to expedite the enrollment process, the Centers for Medicare and Medicaid Services (CMS), formerly HCFA, created separate forms for each type of entity, as opposed to a single "one-size-fits-all" form. As a result, the form that physicians must use is no longer cluttered with questions for other Medicare providers like durable medical equipment vendors.

More information on enrollment is on the CMS Web site at www.hcfa.gov/medicare/enrollment/. The site explains the enrollment process and provides application forms and instructions, important contact names and phone numbers, and answers to frequently asked questions.

While the enrollment form is available online, you cannot submit it electronically. CMS hopes to accept enrollment applications online in the near future, but for now you must mail a printed, signed form to your carrier.

You can also obtain an application form from your local Medicare carrier. For contact information, go to www.hcfa.gov/medicare/enrollment/contacts/.

Last November, carriers began mailing the new application forms to physicians who request them. They were instructed to process any old forms they received until the end of last year.

Q: What is Medicare doing to address carrier delays in processing physician enrollment applications?

A: Carriers must adhere to CMS-set timeframes when processing enrollment applications. (ACP-ASIM and other organizations have expressed concerns about processing delays.) The new carrier application processing timeframes require carriers to do the following:

  • make a decision on 90% of applications within 60 days;
  • make a decision on 99% of applications within 90 days; and
  • obtain missing information for incomplete applications by telephoning applicants.

Q: What should I do if my carrier fails to process my application in the specified timeframe?

A: Contact your local CMS regional office, which monitors carrier performance. For contact information, go to www.hcfa.gov/medicare/enrollment/contacts/, select your state, and look under "regional contact."

If your carrier fails to meet the CMS requirements for processing applications, please contact me at bbaker@acponline.org or 202-261-4533. The College will share the information with CMS so it can make improvements.

Brett Baker is a third-party payment specialist in the College's Washington office. To ask a question about third-party payment or coding issues, contact him at 202-261-4533 or bbaker@acponline.org.

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