Medicare and Speech-Language Pathologists in Private Practice
The Enrollment Process
Enrollment for private practice speech-language pathologists started on June 2, 2009. ASHA has been meeting with the Centers for Medicare and Medicaid Services (CMS) to discuss the implementation of speech-language pathology private practice, including enrollment in the Medicare program. Here are certain steps you may take to prepare for the enrollment process.
Preparing for Enrollment
Obtain Your NPI Now
As a first step, speech-language pathologists interested in enrolling in the Medicare program should obtain a National Provider Identifier (NPI), if you have not already done so. The NPI is a prerequisite for Medicare enrollment. CMS offers more information on the NPI, including a general overview and how to apply. During the application process, you will need the following:
- Taxonomy code for speech-language pathologists: 235Z00000X
- Provider type: 23
Please note that obtaining an NPI is not considered an automatic enrollment into the Medicare program.
See also: ASHA's NPI Information
Familiarize Yourself With the Current Enrollment Process
Enrollment into the Medicare program takes time and the process can vary across Medicare contractors. Familiarizing yourself with the basic procedures and available resources will allow your practice to make a smooth transition once you decide to enroll. Some easy things you can include:
- Getting to know your contractor—Find out who your local Medicare contractor will be by going to CMS's Medicare Administrative Contractor Directory [PDF]. Once in the directory, find your state and identify the contractor providing Medicare Part B services. Getting to know the contractor's Web site and the resources they offer is important. You will be working directly with the contractor during the enrollment process and when you bill Medicare.
- Learning the basic steps to enrollment—Get basic information about the enrollment process from CMS's Web site. You may also want to browse your local Medicare contractor's site for more specific information.
- Understanding the enrollment form—The basic enrollment form is called the CMS 855 form. There are several versions of this form depending on the type of provider or practice that is applying. All individual practitioners use the CMS 855i form [PDF] while each group practice entity enrolls using the CMS 855B form [PDF]. Understanding the type of information required in these enrollment forms will help expedite your enrollment process.
Submitting Your Application
Contact your local Medicare contractor for enrollment inquiries. You may choose one of two ways to submit your enrollment application:
- Internet-Based: CMS prefers that SLPs use the Provider Enrollment Chain & Ownership System (PECOS), an Internet-based scenario-driven application.
Note: Applications submitted via PECOS typically take less time to process than paper-based applications.
- Paper-Based: Paper applications should be mailed to your local Medicare contractor for processing.
- For Physicians and Non-Physician Practitioners (individuals)—CMS 855i form [PDF]
- For Clinics, Group Practices, and Certain Other Suppliers—CMS 855B form [PDF]
You may also submit the following forms with your enrollment application:
- Reassignment of Medicare Benefits—CMS 855R form [PDF]
This form, for employees or contractors of a group practice, names the practice owner or corporation as the recipient of Medicare payments.
- Medicare Participating Physician or Supplier Agreement—CMS 460 form [PDF]
By completing this form, you agree to accept payment directly from Medicare instead of the patient (except for the patient's 20% copayment). "Participating" SLPs cannot charge more than the Medicare fee schedule amount. "Nonparticipating" SLPs are enrolled in Medicare but do not sign the CMS 460 form. Instead, they seek payment (and the 20% copayment) directly from the patient, who then seeks reimbursement from Medicare. Nonparticipating SLPs can only charge patients 95% of the Medicare fee schedule amount, plus a 15% "limiting charge." This results in a 9.5% gain for nonparticipating SLPs (95% of the fee schedule amount plusy 15% limiting charge).
- Authorization Agreement for Electronic Transfer of Funds—CMS 588 [PDF]
This form allows payments to be deposited directly into your bank account.
Here are some useful things to know once you have begun the enrollment process:
- The Non-Physician Practitioner Specialty Code for Speech-Language Pathology is 15
- Dually certified Audiologists/Speech-Language Pathologists must submit a separate enrollment application for each specialty if you want to enroll as more than one non-physician specialty type.
Paper-Based Enrollment Application
- We assume that Section 2J Physical Therapists/Occupational Therapists in Private Practice also applies to Speech-Language Pathologists and should therefore be completed. We have notified CMS that SLPs should be included in this section.
PECOS (Online) Enrollment Application
- Medical School Selection—If your institution is not listed, scroll down to the "O" section and select "Other."