The start date for private-practice speech-language pathologists to enroll in Medicare—June 2, 2009—is fast approaching. Below is a checklist of actions to take now to prepare to enroll in Medicare as soon as the enrollment period begins.
Get your NPI number. You must have your National Provider Identifier (NPI) before you can submit a Medicare enrollment application. Applications may be submitted electronically or on paper. Instructions are available on the ASHA Web site. During the application process, you will need the following:
- Taxonomy code for speech-language pathologists: 235Z00000X
- Provider type: 23
Determine your business type. Before enrolling, you also need to determine what form you want your business to take—for example, you may want to form a corporation or be a sole proprietorship. There are a number of options, with advantages and disadvantages for each. Information on business structures and practices is available on the ASHA Web site:
Identify your Medicare contractor. The Medicare contractor in your area will process your enrollment application and—once you are a Medicare provider—will also process your claims. Your contractor may be a Part B carrier or Medicare Administrative Contractor (MAC). CMS is replacing all Part B carriers (and fiscal intermediaries) with MACs by 2010.
- Information on determining your Medicare contractor is available on the ASHA Web site.
Submit Medicare enrollment application and any additional forms. Medicare contractors will not accept enrollment applications until June 2. An individual SLP must complete a CMS-855i form [PDF] to bill for individual services. A business or group practice would also complete a CMS-855B form [PDF]. These forms can be filled out in paper form and sent to the Medicare contractor.
However, CMS encourages individual SLPs to use the online Provider Enrollment Chain and Ownership System (PECOS). This process cannot be used for 855B forms.
SLPs may also submit the following forms:
- CMS-855R [PDF], "Reassignment of Medicare Benefits." This form, for employees or contractors of a group practice, names the practice owner or corporation as the recipient of Medicare payments.
- CMS-460 [PDF], "Medicare Participating Physician or Supplier Agreement." By completing this form, you agree to accept payment directly from Medicare instead of the patient (except for the patient's 20% copayment).
- CMS-588 [PDF], "Authorization Agreement for Electronic Funds Transfer." This form allows payments to be deposited directly into your bank account.
Understand Medicare billing and coding rules. SLPs should develop an understanding of billing and coding under Medicare prior to billing for services. This information is available on the ASHA Web site.
Keep updated with ASHA. ASHA will continue to provide up-to-date information on private practice and Medicare.