Medicare Provider/Supplier Enrollment
Before you can become a Medicare provider/supplier for patients, whether you are a practitioner or own a health care service such as a home health agency, hospice, nursing home, or durable equipment supply company, there are multiple steps you need to do before you can bill Medicare on those products or services.
In order for you to do that, you must first complete an online application at the United States Department of Health and Human Services website. This online application process is called the Providers Enrollment, Chain and Ownership System (PECOS). This is the only way for you to apply to become a Medicare provider in the United States. Once you apply, a Medicare Administrative Contractor (MAC) reviews it and processes it, then notifies you regarding your status as a Medicare provider/supplier.
Steps to ensure a speedy processing of your Medicare provider application:
- Register with the National Plan and Provider Enumeration System (NPPES) – By registering in NPPES, you will create a user ID, this ID will be used to obtain your National Provider Identifier (NPI). This will also be used to log in to the PECOS website where you will be applying to become a Medicare provider/supplier. Your user ID cannot be changed, so be careful in choosing one.
- Obtain Your National Provider Identifier (NPI) – This is a unique 10-digit number and will depend on the medical care you are providing. It may be individual, organizational or both types of NPI. You can obtain your NPI though the online application HERE or you may download the PDF version of the NPI application. Once you've completed the application form, you may mail it to the NPI Enumerator address listed on the form. For those who cannot access the application online, you may call (800) 465-3203 and request a paper copy.
- Complete the Medicare Enrollment Application – The next step will be to complete the Medicare Enroll Application. You can do this through Provides Enrollment, Chain and Ownership System (PECOS). You must fill out CMS 855A, if you are an institutional provider like home health agencies, outpatient physical therapy services, and hospice. But if you sell supplies or medical equipment, fill out CMS 855S, this is also called the MEA for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS). For, physicians and non-physician practitioners use CMS 855I. For reassignment of Medicare benefits, use CMS 855R.
- Don't Forget the required documents – Make sure you have all necessary documents to process your application. The process may take 90 days or longer, and if you need additional documents to submit, the processing time will reset.
- The documents needed are:
- Written confirmation from the Internal Revenue System (IRS) that has your legal business name and tax ID number.
- Banking information if you have an agreement with a bank to cover Medicare payments.
- Copies of Federal Drug Administration (FDA) certifications and Clinical Laboratory Improvement Amendment and approval documents for each provider, suppler, and location, including Drug Enforcement Administration (DEA) numbers when necessary.
- The documents needed are:
- Pay the Necessary Fee – As of 2019, the fee that you have to pay is $586 and is adjusted annually.