decisionhealth Newsletters, Part B News - 2011 Issue 6 (June)
Proposed new enrollment form could give ease referring doctor caused denials
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Article Overview
This article covers a CMS proposal for a new Medicare enrollment form designed for physicians and non-physician practitioners who only need to order or refer services, not submit claims. It is relevant to billing staff, coders, compliance teams, and provider enrollment personnel who deal with Medicare claim denials and referring-provider identification issues. The discussion focuses on the administrative purpose of the form, the problems it is meant to address, and how the proposed process differs from existing enrollment steps.
Why This Topic Matters
Medicare denials can occur when referring or ordering providers are not properly identified in enrollment systems. Understanding proposed CMS enrollment changes helps practices anticipate workflow updates and reduce avoidable payment issues.
Article Sections
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CMS proposal for a streamlined enrollment application
Introduces the proposed enrollment form and the administrative problem it is intended to address for Medicare-participating practices.
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Current enrollment and referral process
Summarizes the existing Medicare enrollment approach for providers who refer or order services without regular billing activity.
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How the proposed form would work
Describes the general structure and purpose of the new application and the categories of information it would collect.
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Industry reaction and implementation context
Includes commentary on the proposed process and its expected effect on administrative burden and Medicare contractor workflows.
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The CMS-855O in practice
Outlines the form’s major sections and the types of information expected from applicants.
What You Will Learn
- Why Medicare claim denials can occur when referring providers are not properly enrolled
- What the proposed CMS enrollment option is meant to accomplish
- How the proposal relates to existing Medicare enrollment workflows
- What general information categories are included in the draft application
- How the change may affect provider enrollment and billing operations
Who Should Read This
- Medical coders
- Billing staff
- Provider enrollment staff
- Compliance professionals
- Practice administrators
- Physicians and non-physician practitioners
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