October 14, 2008 Features

Practical Steps SLPs Can Take to Prepare for Medicare Enrollment

Private-practice speech-language pathologists can take practical steps now to prepare for enrollment in the Medicare program prior to the expected rollout in May or June 2009. ASHA staff has been meeting with the Centers for Medicare and Medicaid Services (CMS) to discuss the implementation of speech-language pathology private practice, and will alert members when the exact rollout date is confirmed. The following questions and answers are designed to help you prepare for enrollment.

Q: Do I need to secure an NPI number before I apply to Medicare?

Yes. Application for a National Provider Identifier (NPI) number is a separate process from Medicare enrollment and can be completed easily now. It's important to remember that obtaining an NPI number is not considered an automatic enrollment into the Medicare program.

Q: How do I obtain an NPI number?

Most practitioners apply online or by mail:

  • Online at the NPPES Web site
  • By mail—call 800-465-3203 to have an application form mailed to you or print it from the NPI Web site identified above.

Q: Is there discipline-specific information that SLPs must enter on the NPI application?

Yes. You will be asked to enter a taxonomy code for SLPs; it is 235Z00000X. You will also have to enter a provider type, which is 23.

Q: Do sole proprietorships and group practices use different NPI numbers?

Yes. If your practice is a sole proprietorship and not incorporated, you must apply for a Type I NPI number (individual). If you are incorporated and/or have other practitioners working for you, you need to have a Type II NPI number (group) as well as an individual NPI.

Q: I need more information on NPI numbers. Where can I find it?

There is considerable NPI information on the ASHA Web site. CMS offers additional information on the NPI on their Web site, including a general overview and how to apply.

Q: When Medicare enrollment opens for SLPs next spring, where will I send my enrollment application?

You will submit your application to a Medicare contractor identified as a Part B carrier or a Medicare Administrative Contractor (MAC). CMS is in the process of gradually replacing each carrier with a MAC; as a result, a Web site or phone number in the CMS intermediary-carrier directory [PDF] may forward you to a new MAC site. In advance of enrollment, ASHA recommends that you get to know your Medicare contractor and the resources offered through its Web site. You will be working directly with the contractor during the enrollment process and when you bill Medicare.

Q: As a sole proprietor, what basic enrollment form will I submit to the contractor?

You will need to complete the CMS-855i form, using your NPI number. The "i" stands for "individual." For information about the enrollment process, visit the CMS Web site. The site includes the complete CMS-855i form. You may also want to browse your local Medicare contractor's site for more specific information.

Q: I use a business name for my practice instead of my own name. Is there a special enrollment form for a business or group practice?

Yes. In this case you would submit the CMS-855B form. This same form is appropriate for group practices. A copy of the form and instructions are on the same site as the CMS-855i. Remember that you must have an NPI group number in order to submit the 855-B form.

Contact your local Medicare contractor for enrollment inquiries. Keep in mind that enrollment of private practice SLPs does not begin until May or June of 2009, so your contractor may not yet have information specific to your practice.

For further information, contact reimbursement@asha.org.

Note: Links to most of the Web sites identified here are available on ASHA's Web site.

Mark Kander, director of health care regulatory analysis, can be reached at 301-296-5669 or mkander@asha.org.

cite as: Kander, M. (2008, October 14). Practical Steps SLPs Can Take to Prepare for Medicare Enrollment. The ASHA Leader.


Advertise With UsAdvertisement