Top 5 Accidental Ways

YOUR MEDICARE CHECKS MAY SUDDENLY STOP

You’ve added a doctor or nurse practitioner to your group a couple of months back, maybe even a few years ago, and have been billing the provider’s services smoothly for months, when suddenly you start getting denials. It turns out, a revalidation request for the individual provider enrollment was mailed to an old address – the doctor’s old group, or your own group’s old address. Because you were unaware of this notice, Medicare revoked the doctor’s billing privileges due to non-response.

This scenario happens more often than it should, because Medicare does not require changing one’s individual enrollment in order to join a new group and start billing under that group.

But when it’s time to send the revalidation request, it will only refer to the provider’s individual enrollment information, not your group enrollment. Medicare carriers will not bother looking up current Medicare claims submitted by that provider to see where his or her active practice locations are. They will rely on whatever address you left entered on that much overlooked enrollment.

How to Avoid this

Always check individual enrollment profiles, especially the correspondence address on record. If you are the practice manager, and the enrollment was handled by a different person or a previous manager, take the extra step to have providers visit their individual PECOS accounts. If deactivated, your provider may be subject to a lapse in coverage starting from the deactivation date to the date the revalidation application was accepted. Services performed during the lapse in coverage will not be paid and this could present as a considerable financial loss to your practice.

Another way to avoid this

Check the CMS revalidation lookup periodically, to see if any of your providers are due for revalidation. CMS enters a date on the look up 6 months before revalidation is due. Before that 6-month period, it will only say TBD, so you should have enough time to prepare for it, even if you do not receive the revalidation letter in the mail.

Although providers maintain and pay close attention to Medicare enrollment and paperwork requirements, checks may still stop. Find out top causes and solutions to MC payments that are stopped accidentally.

There are legitimate reasons why a Medicare provider number can get deactivated.

ENROLLMENT / ADDITIONAL INFORMATION YOU MAILED THAT WAS NEVER RECEIVED

The dog ate your homework: that’s what Medicare will probably think, if you tell them you mailed your response which they never received. But you’ll be surprised how often mail actually gets lost in their receiving queue. The scanning of mailed responses takes a week or two before it appears on the carrier’s correspondence system. Faxes may take days. If you don’t remember to call the support hotline to confirm, it might be too late before you learn your package was lost.

How to Avoid this : When mailing a response, send via courier. Medicare usually provides a PO Box for enrollments but when followed up through a phone call, they can provide you with a physical address where you can send your reply via courier.

If you don’t want to spend the extra dollars for courier service, you can always create an online Priority Mail USPS label with free tracking – that will at least give you proof of the exact date your response was received. Medicare carriers will make the effort to locate your mail if you have a tracking number or any proof of receipt.

Another way to avoid this : Always check if the analyst is giving you the option to reply by email. Some Medicare carriers allow this, or they prefer you to respond by fax. This cuts the wait period for confirmation. If they are asking for original written signatures, you can always send them an advance scanned copy of what you mailed and inform them that the original copies are in the mail.

If you don’t want to spend the extra dollars for courier service, you can always create an online Priority Mail USPS label with free tracking – that will at least give you proof of the exact date your response was received. Medicare carriers will make the effort to locate your mail if you have a tracking number or any proof of receipt.

MISSING SIGNATURE(S) ON PECOS ENROLLMENT

So you’ve decided to join the 21st Century by submitting your revalidation applications online through PECOS instead of by paper. Your doctor goes through all the sections, checks for errors and then proceeds to click the sign now boxes to complete the enrollment. You receive an email from PECOS confirming receipt of your enrollment. You think, “Mission Accomplished”. So now, you are just waiting for a letter of approval or maybe an email from the analyst with requests for revisions.

Three weeks later, instead of an approval, you get a notice that your application was returned due to missing signatures. If you had waited the last minute to submit the enrollment, it may mean you have missed the revalidation deadline, and your number is now in the process of deactivation. How did that happen?

If you were submitting a revalidation for a group or even for an incorporated practice, your enrollment may likely have required more than one signature. When the doctor or owner is asked to sign, PECOS does not explicitly differentiate your 855B enrollment from your EFT enrollment and your 855R individual reassignment enrollment. So when the doctor e-signed the final pages of the online enrollment, he was only signing the main 855B enrollment and possibly half of an 855R enrollment. The other signatures were never required on that page. A PECOS electronic signature request email would have been sent to your doctor notifying him of the additional requirement which he may have ignored because he remembers signing those last pages.

How to avoid this: After submitting an enrollment, have the doctor log out of PECOS, then log back in after a minute or two and check the manage signatures section on the first page. The doctor will see if there are additional e-signatures needed for that submission.

ENROLLMENT / ADDITIONAL INFORMATION YOU MAILED THAT WAS NEVER RECEIVED

The dog ate your homework: that’s what Medicare will probably think, if you tell them you mailed your response which they never received. But you’ll be surprised how often mail actually gets lost in their receiving queue. The scanning of mailed responses takes a week or two before it appears on the carrier’s correspondence system. Faxes may take days. If you don’t remember to call the support hotline to confirm, it might be too late before you learn your package was lost.

How to Avoid this : When mailing a response, send via courier. Medicare usually provides a PO Box for enrollments but when followed up through a phone call, they can provide you with a physical address where you can send your reply via courier.

If you don’t want to spend the extra dollars for courier service, you can always create an online Priority Mail USPS label with free tracking – that will at least give you proof of the exact date your response was received. Medicare carriers will make the effort to locate your mail if you have a tracking number or any proof of receipt.

Another way to avoid this : Always check if the analyst is giving you the option to reply by email. Some Medicare carriers allow this, or they prefer you to respond by fax. This cuts the wait period for confirmation. If they are asking for original written signatures, you can always send them an advance scanned copy of what you mailed and inform them that the original copies are in the mail.

ENROLLMENT / ADDITIONAL INFORMATION YOU MAILED THAT WAS NEVER RECEIVED

The dog ate your homework: that’s what Medicare will probably think, if you tell them you mailed your response which they never received. But you’ll be surprised how often mail actually gets lost in their receiving queue. The scanning of mailed responses takes a week or two before it appears on the carrier’s correspondence system. Faxes may take days. If you don’t remember to call the support hotline to confirm, it might be too late before you learn your package was lost.

How to Avoid this : When mailing a response, send via courier. Medicare usually provides a PO Box for enrollments but when followed up through a phone call, they can provide you with a physical address where you can send your reply via courier.

If you don’t want to spend the extra dollars for courier service, you can always create an online Priority Mail USPS label with free tracking – that will at least give you proof of the exact date your response was received. Medicare carriers will make the effort to locate your mail if you have a tracking number or any proof of receipt.

Another way to avoid this : Always check if the analyst is giving you the option to reply by email. Some Medicare carriers allow this, or they prefer you to respond by fax. This cuts the wait period for confirmation. If they are asking for original written signatures, you can always send them an advance scanned copy of what you mailed and inform them that the original copies are in the mail.

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