Obtaining and Maintaining your Medicare PTAN and Accreditation Certifications

1. ”Tuesday at 10 “ April 8, 2014 Obtaining and Maintaining your Medicare PTAN and Accreditation Certifications Presented by Argosy Group, Inc Tel: 888-691-2746 info@argosygroup.org

2. Disclaimer • It is the intent of the Argosy Group to provide up to date, accurate information . The information contained in this presentation is for educational purposes only and is not presented as legal advice or with any expressed or implied warranty of accuracy. • Argosy Group encourages you to visit and communicate with your Medicare Regional DMEMAC and your Accreditation Agency often

3. 855S Form • Initial Enrollment form • Used to communicate with NSC (Changes of address, Accreditation, Product Adds, ownership changes, designated official changes, etc) • Attach all documents requested • Site Visit by NSC before PTAN is issued. http://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/downloads/cms855s.pdf

4. Supplier Standards • All DMEPOS providers must abide by the DMEPOS Supplier Standards • Latest version 4/1/2014 • http://www.palmettogba.com/palmetto/providers.nsf

5. PECOS • Online enrollment is now available for all DMEPOS suppliers! The Provider Enrollment Chain Ownership System (PECOS) allows suppliers to enroll, make changes to existing enrollment records, re-enroll, and check the status of products, services and company officials. • view the CMS PECOS Web site.

6. The CMS 588 Form DMEPOS suppliers initially enrolling or submitting an application for a new location are required to complete and submit the current Authorization Agreement for Electronic Funds Transfer (EFT) Agreement (CMS 588). Note: Suppliers revalidating should submit the necessary CMS 588 form(s) if not already enrolled to receive payments through EFT. The form must have the original signature of an authorized or delegated official listed on the CMS 855S..The CMS 588 form can be found on the CMS Web site.

7. Medicare DMEPOS Supplier Participation Agreement - CMS 460 • Medicare Participation To sign a participation agreement is to agree to accept assignment for all covered services that you provide to Medicare patients. A supplier's participation status is referring to whether they wish to accept assignment on claims or not. Although there are some items on which assignment is mandatory regardless of the supplier's participation status. It is not, in any way, referring to whether the supplier wishes to participate in the Medicare program. New suppliers, who have not previously submitted a participation agreement, have up to 90 days after the date its number is assigned to choose to participate. If a supplier does nothing, it will be listed as .

8. PTAN Inactivated Medicare suppliers are required to submit claims at least once within four consecutive quarters to maintain billing privileges. A comprehensive report of suppliers who show no record of filing a claim within the specific period. The NSC will deactivate the supplier’s billing privileges and send written correspondence to the address on file. In order to reactivate billing privileges, the supplier will need to reapply, pay an enrollment application fee, and show compliance with all standards as necessitated by the supplier type. Suppliers choosing to contest the deactivation must show proof of billing during the time period in question.

9. Change of Ownership While there may be a variety of legal definitions and purchase options, most of the changes of ownership received by the NSC are completed using one of the following methods, which are defined as follows: • An asset purchase is the purchase of the assets of a business only. The buyer will be operating the business under a new tax identification number (TIN). • A stock purchase is the purchase of all assets and liabilities where the buyer will retain and operate the business under its existing TIN. • Suppliers should keep the following in mind with regards to changes in ownership: • Supplier Standard #2 requires a supplier to report to the NSC any change in information within 30 days of the change . Supplier numbers are associated with the TIN. If the buyer chooses to purchase the assets and liabilities, retaining the TIN, then the supplier file only needs to be updated. If there is a change in TIN, then the new owner must obtain a new Medicare Identification Number.

10. PTAN Revalidation - NSC 42 CFR section 424.57(e) requires the National Supplier Clearinghouse (NSC) to revalidate suppliers every three years. The revalidation process allows the NSC to determine if the supplier is in compliance with the supplier standards and all information is still accurate. Suppliers may revalidate via Internet-based PECOS or by downloading a CMS-855S enrollment application. The revalidation process includes a site visit. TIME SENSITIVE

11. CEDICommon Electronic Data Interchange • Decide if you will be sending claims electronically directly to Medicare or through a 3rd party biller or clearinghouse. • If you plan to send claims directly to Medicare, you will need to choose a Network Service Vendor (NSV) to connect to send and receive files. • Verify the transaction options you will selecting. • Complete CEDI enrollment forms. • http://www.ngscedi.com

12. NPINational Provider Identifier • https://npiregistry.cms.hhs.gov • All health care providers must have an NPI. • As an Individual Provider, you may only have a single NPI, which will be associated with your unique, individual information. Once you login to NPPES, you will be able to complete your NPI application.

13. Surety Bond • What is a DMEPOS surety bond? A surety bond is issued by an entity (the surety) guaranteeing that a DMEPOS supplier will fulfill an obligation or series of obligations to a third party (the Medicare program). If the obligation is not met, the third party will recover its losses via the bond. $50,000 Bond Amount required. • How do I obtain a surety bond? Contact one of the sureties identified on the U.S. Department of Treasury's “Listing of Certified (Surety Bond) Companies;” the Web site for this listing is www.fms.treas.gov/c570/c570_a-z.html . For purposes of the surety bond requirement, these sureties are considered “authorized” sureties, and are therefore the only sureties from which a bond may be obtained. • Regarding multiple DMEPOS supplier locations, you must obtain a bond for each location? • If your bond lapses, replacement bond will be min $100,000.

14. Accreditation • Medicare Modernization Act of 2003 required that by January 2009 all DMEPOS providers must be Accredited by an Accreditation company authorized by CMS. • Exemption for Pharmacies only providing minimal DMEPOS items (diab test strips, cane, crutch) whereby DME business is less than 5% of their revenue. • 3 year Accreditation. • Must be renewed every 3 years. • If Accreditation lapses, PTAN # affected.

15. Q & A “Voice” Refill Reminders DME Audit Shield Operations Consulting Argosy Group, Inc Accreditation Preparation DME Billing Service & AR Collector Join us at 10:00 a.m. CST on Tuesday, May 13, 2014 for another “Tuesday at Ten Presentation”

16. Let Argosy Group help younavigate your DME business • Medicare Compliance driven Billing Service/Application – RT RX DME Billing Service • Accounts Receivable Recovery and Management • Real-Time On-Line Insurance verification • Independent Chart Audit Programs • On-site or On-line Consulting (Intake to Billing) • Policy & Procedure Manuals Development • Accreditation Readiness & Mock Reviews • On-line Continuing Education (CEUs) • Reimbursement Training The Argosy Group, Inc and Raintree RX has given us the confidence to spend more time growing our business and less time on paper-work. It is user friendly and cost-effective. Filing of claims is timely and questions are answered right away. I highly recommend Raintree RX as the new age “Pharmacy & Specialty DME” billing solution. Rose Johnson, DME Manager Able Care Pharmacy & Medical Supplies, Enfield CT

17. Reference Sites • www.cms.hhs.gov CMS • www.cms.hhs.gov/manuals/downloads • www.medicarenhic.com (Region A) • www.ngsmedicare.com (Region B) • www.cignagovernmentservices.com (Region C) • www.noridianmedicare.com (Region D) • www.dmepdac.com (Medicare Pricing, Data Analysis and Coding)